Question Form

City*
County / State / Province*
Country*
Name*
First Last
Age*
Helpers Name: Lewis Rowlands
Phone Number*
Date of last test*
On a scale of 0-5 how well are you doing the following procedures?
Diet*
Supplements*
Water*
Lifestyle*
Rest*
Sauna or heatlamp*
Spinal Twist*
Foot Rubs*
Coffee Enemas*
Meditation*
Skin Brushing*
What supplements are you currently taking?*
Medications?
Please write the question clearly and concisely in your own words. If there is more than one question, list them 1., 2., 3., etc.:*