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VFS Assessment Level 1
Level 1
Rate your commitment level 1-10 for addressing your primary health concern, and be brutally honest. Are you looking for a magic pill (1-3), still waiting for someone to tell you what you want ot hear (4-7), or ready to do the actual work (8-10)? *
5
Full Name
*
Email Address
*
Password
*
Enter Password
Confirm Password
*
Confirm Password
Phone Number
Date
Date of Birth
*
Biological Sex
*
Male
Female
Height
*
Enter height like
5.6
for 5 feet 6 inches, or
300
for centimeters.
Unit
Feet
Centimeter
Height unit
Weight
*
Enter weight like
70
for kilograms or
154
for pounds.
Unit
Ibs
Kgs
Weight unit
Country
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chile
China
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (DRC)
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North Korea)
Korea (South Korea)
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Panama
Papua New Guinea
Peru
Philippines
Poland
Portugal
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Spain
Sri Lanka
Switzerland
United Arab Emirates
United Kingdom
United States
Primary Health Goal
*
Weight Loss
Increase Energy
Improve Digestion
Better Sleep
Reduce Stress
Hormone Balance
Other
Top 3 Health Concerns (select up to 3)
*
Fatigue
Digestive Issues
Weight Gain
Sleep Problems
Mood Issues
Pain
Hormonal Issues
Brain Fog
Skin Problems
Other
Do you experience bloating or gas after meals?
Never
Rarely
Sometimes
Often
Daily
Do you have irregular bowel movements (constipation or diarrhea)?
Never
Rarely
Sometimes
Often
Daily
Do you have heartburn, acid reflux, or stomach pain?
Never
Rarely
Sometimes
Often
Daily
Do you have history of multiple antibiotic courses or hospital stays?
No
1-2 times
3-5 times
6+ times
Do you easily get food poisoning when others eating the same food don't?
Never
Rarely
Sometimes
Often
Always
Do you have difficulty losing weight despite diet and exercise?
No
Slight difficulty
Moderate difficulty
Significant difficulty
Do you feel tired even after adequate sleep?
Never
Rarely
Sometimes
Often
Always
Do you feel cold frequently or have cold hands/feet?
Never
Rarely
Sometimes
Often
Always
Do you crave salt or feel lightheaded when standing quickly?
Never
Rarely
Sometimes
Often
Always
How often do you wake up in the middle of the night?
Never
1-2 nights/week
3-4 nights/week
5-6 nights/week
Every night
Do you rely on caffeine to function normally?
Never
Occasionally
Most days
Daily requirement
Multiple doses daily
Do you have irregular menstrual cycles or hormonal symptoms?
No
Mild
Moderate
Severe
Have your periods become irregular in the past 2 years?
No
Slightly irregular
Moderately irregular
Very irregular
Stopped completely
Do you experience hot flashes or night sweats?
Never
Rarely
Sometimes
Often
Daily
Do you have low libido or sexual dysfunction?
No
Mild
Moderate
Severe
Hormonal Symptoms
Periods Become
Night Sweats
Do you experience mood swings, anxiety, or depression?
Never
Rarely
Sometimes
Often
Daily
Do you have difficulty concentrating or brain fog?
Never
Rarely
Sometimes
Often
Daily
How often do you have difficulty finishing tasks you start?
Never
Rarely
Sometimes
Often
Always
How often do you worry about things you weren't worried about before?
Never
Rarely
Sometimes
Often
Constantly
Do you have trouble falling asleep or staying asleep?
Never
1-2 nights/week
3-4 nights/week
5-6 nights/week
Every night
Do you have difficulty staying asleep or wake up frequently during the night?
Never
1-2 nights/week
3-4 nights/week
5-6 nights/week
Every night
Do you experience numbness, tingling, or nerve pain?
Never
Rarely
Sometimes
Often
Daily
Do you have numbness or tingling in hands and feet?
Never
Rarely
Sometimes
Often
Daily
Do you have headaches or migraines regularly?
Never
Monthly
Weekly
Several times/week
Daily
Do you have ringing in ears (tinnitus) or sound sensitivity?
Never
Rarely
Sometimes
Often
Constant
Do you have high blood pressure or heart palpitations?
No
Borderline
Mild
Moderate
Severe
Do you experience chest pain or shortness of breath?
Never
With exertion only
Sometimes at rest
Often at rest
Frequently
Do you have poor circulation or swelling in extremities?
Never
Rarely
Sometimes
Often
Daily
Do you get sick frequently or have difficulty recovering from illness?
No
Occasionally
Moderately
Frequently
Constantly
Do you have allergies or food sensitivities?
None
Mild
Moderate
Severe
Multiple severe
Do you have white coating on tongue or recurrent yeast infections?
Never
Rarely
Sometimes
Often
Persistent
Do you have recurring vaginal, nail, skin, or other fungal infections?
Never
Rarely
Sometimes
Often
Persistent/Multiple
Do you have chronic cough, congestion, or breathing difficulties?
Never
Seasonal
Sometimes
Often
Constant
Do you have asthma, allergies, or sinus problems?
None
Mild
Moderate
Severe
Multiple conditions
Do you have chronic joint pain or stiffness?
None
Mild
Moderate
Severe
Debilitating
Do you have muscle pain, weakness, or cramping?
Never
Mild
Moderate
Severe
Frequent
Do you have restless leg syndrome?
Never
Rarely
Sometimes
Often
Nightly
Do you have chemical sensitivities or react to environmental toxins?
No
Mild sensitivity
Moderate reactions
Severe reactions
Multiple chemical sensitivity
Do you react to perfumes, fragrances, or cleaning products?
Never
Rarely
Sometimes
Often
Always/Severely
Do you have difficulty tolerating medications or supplements?
No
Occasional
Frequent
Most supplements
Almost everything
Do you live or work in a building with water damage or mold?
No
Past exposure
Possible current
Confirmed current
Severe exposure
Do you have loss of taste or smell?
Never
Occasionally
Frequently
Constantly
Do you have chronic fatigue or low energy levels?
Never
Mild fatigue
Moderate fatigue
Severe fatigue
Debilitating fatigue
Do you crash after meals or need frequent snacks?
Never
Rarely
Sometimes
Often
Always
Do you feel worse after exercise rather than energized?
Never
Rarely
Sometimes
Often
Always
Do you feel overwhelmed or unable to handle stress?
Never
Rarely
Sometimes
Often
Constantly
Do you get energized after 6 PM or feel wired at bedtime?
Never
Rarely
Sometimes
Often
Every night
Do you snore or have sleep apnea?
Never
Rarely
Sometimes
Often
Diagnosed sleep apnea
Have you had multiple courses of antibiotics in the past 5 years?
None
1-2 courses
3-5 courses
6-10 courses
More than 10
Do you have a history of long COVID or post-viral syndrome?
No
Suspected
Probable
Confirmed
Do you live or work in a building built before 1978?
No
Possibly
Yes
Do you have pets?
No
Indoor cats
Dogs
Multiple pets
Farm animals
Submit
If you are human, leave this field blank.
Δ
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