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Dr. Rashel Tahzib
Advance Health Functional Medicine
Home
Mission
About Dr Rashel
My Story
Mission and Purpose
Education and Background
About Functional Medicine
Functional Practice Style
Practice Specialties
Services
Mood and Concentration Optimization
Advanced Diagnostics
Autoimmune Disease
Bio-Identical Hormone Replacement Therapy
Candida and SIBO Elimination
Chronic Fatigue / Fibromyalgia
Detoxification / Heavy Metals / Environmental Toxins
Digestive Problems
Fertility Optimization
Functional Medical Weight Loss
Functional Medicine Consultations
Insulin Resistance / Abdominal Obesity
Low Testosterone & Men’s Health
Lyme Disease / Chronic Infections
Thyroid Health Optimization
Women’s Health, Hormone Imbalance
Sleep Issues
FUNCTIONAL WELLNESS CONSULTATIONS
Patient Center
Online Health Assessments
Becoming a Patient
What to Expect And How it Works
What is Functional Medicine
The 9 Essential Pillars to Advance Health
The Right Order of Things
Frequently Asked Questions
Functional Medicine Intake Forms
Consents
Resources
Functional Test Kits
Nutritional Supplements
Stress Reduction Techniques
Food & Cooking Guidelines
Specialized Dietary Guidelines
Functional Medicine Educational Handouts
Controversies in the Diagnosis and Treatment of Hypothyroidism
GI Websites and Reading Lists
Informative Websites & Resources
Store
Supplements
Wellness Essentials
Protein / Collagen
Health Restore Kits
Functional Lab Kits
Programs
Recipes
Blog
Contact
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Home
Mission
About Dr Rashel
My Story
Mission and Purpose
Education and Background
About Functional Medicine
Functional Practice Style
Practice Specialties
Services
Mood and Concentration Optimization
Advanced Diagnostics
Autoimmune Disease
Bio-Identical Hormone Replacement Therapy
Candida and SIBO Elimination
Chronic Fatigue / Fibromyalgia
Detoxification / Heavy Metals / Environmental Toxins
Digestive Problems
Fertility Optimization
Functional Medical Weight Loss
Functional Medicine Consultations
Insulin Resistance / Abdominal Obesity
Low Testosterone & Men’s Health
Lyme Disease / Chronic Infections
Thyroid Health Optimization
Women’s Health, Hormone Imbalance
Sleep Issues
FUNCTIONAL WELLNESS CONSULTATIONS
Patient Center
Online Health Assessments
Becoming a Patient
What to Expect And How it Works
What is Functional Medicine
The 9 Essential Pillars to Advance Health
The Right Order of Things
Frequently Asked Questions
Functional Medicine Intake Forms
Consents
Resources
Functional Test Kits
Nutritional Supplements
Stress Reduction Techniques
Food & Cooking Guidelines
Specialized Dietary Guidelines
Functional Medicine Educational Handouts
Controversies in the Diagnosis and Treatment of Hypothyroidism
GI Websites and Reading Lists
Informative Websites & Resources
Store
Supplements
Wellness Essentials
Protein / Collagen
Health Restore Kits
Functional Lab Kits
Programs
Recipes
Blog
Contact
Gut Health Quiz? Is your Gut Function Impaired?
Could you have Imbalanced Gut Bacteria, candida overgrowth, SIBO, Leaky Gut, Poor Digestion)? Check Mark any that apply to you to find out!
Name
*
First
Last
Email
*
Phone
*
The Questions
Do you frequently feel bloated?
*
Select one
Yes
No
Do you pass gas frequently?
*
Select one
Yes
No
Do you pass foul smelling gas?
*
Select one
Yes
No
Do you experience abdominal pain or cramping?
*
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Yes
No
Do you have alternating constipation or diarrhea?
*
Select one
Yes
No
Do you have Loose Stools?
*
Select one
Yes
No
Do you experience constipation, or hard, dry, or small pellet like stool?
*
Select one
Yes
No
Does your tongue gets Coated, fuzzy or white?
*
Select one
Yes
No
Have you been diagnosed with one or more nutritional deficiencies such as low magnesium, zinc, Iron and especially B12?
*
Select one
Yes
No
Have you been Diagnosed with diseases such as: Hashimotos, Rosacea, Psoriasis, Rheumatoid arthritis Fibromyalgia, Chronic fatigue, Crohn’s or Ulcerative Colitis, asthma, IBS, Acne?
*
Select one
Yes
No
Have yiou been diagnosed with another autoimmune disease?
*
Select one
Yes
No
Do you struggle with Brain Fog or difficulty concentrating?
*
Select one
Yes
No
Do you struggle with Depression or Anxiety?
*
Select one
Yes
No
Any Comments?
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