Self Assessment

Self Assessment

Where Do I Start? Integrative Intake Screening Questionnaire

It can be challenging to find the healthcare approach that best suits your health concerns and belief system. We’ve created this questionnaire to help guide you in your decision. For more support, please submit your completed form to our reception staff for review by our Clinic Director, or schedule an introductory consultation with one or more practitioners in our facility.

Lyme Disease and Co-Infection Symptom Questionnaire

Lyme disease is an infection by a type of microbe called a spirochete that has an incredible ability to adapt and survive as our immune system attempts to get rid of it. People with a Lyme infection often have additional infections (co-infections), and the synergy amongst these organisms can create a vast array of symptoms unique to the person experiencing the illness. This, coupled with insufficient scientific understanding and poor laboratory testing options, makes accurate diagnosis challenging. People with chronic Lyme disease must be persistent in their efforts to find a Lyme-literate health practitioner so that proper treatment may be pursued.

Insomnia Questionnaire

Sleep is critical for disease prevention and healing. Up to 40% of Canadians have insomnia symptoms and up to 13% qualify as having a sleep disorder. Generally speaking, if you’re distressed by poor sleep at least 3 nights a week for a minimum of 3 months, you qualify as having insomnia disorder.

Sleep medications do not restore ideal sleep cycles and full healing capacity. Insomnia is a complicated condition, at times involving all the hormones and neurotransmitters, nervous system, circulatory system, and immune system. This questionnaire is designed to help us better identify and treat the underlying cause of your insomnia so that healthful sleep can be restored.

Fatigue Questionnaire

Fatigue can be an elusive constellation of symptoms. It’s not nicely packaged in one location of the body and it affects people in an incredible variety of ways, so that traditional methods of categorizing become inadequate. This single approach leaves some people to struggle through their day or question whether their symptoms are “all in their head”. Please use this self-questionnaire as a guide to provide insight into possible contributing factors to your fatigue. Please note that a generic tool such as this cannot be specific enough to diagnose your individual health concerns.

Heavy Metal Exposure Screening

All of us have been exposed to some degree, to heavy metals. These include naturally-occurring arsenic in ground water, lead waste from industry, cadmium from cigarette smoke, and mercury in fish. The health concerns resulting from a high body burden of metals are vast and variable. However, ongoing research continues to shed light on this area so that the underlying cause of many health conditions can be treated more effectively.

Mental Exhaustion and Burnout

We’re all faced with stress from time to time, but did you know that the impact of stress can build up and play an important role in whether or not you become ill – physically and mentally? To calculate your risk of experiencing mental exhaustion/burnout, add up the scores associated with each life event that has been a source of stress in your life over the previous year.

Electromagnetic Radiation Exposure

Electromagnetic frequencies (EMF), such as what cell phones and WiFi internet routers emit, is a serious health risk. Rigorous scientific studies on the human health effects of chronic EMF exposure suggest significant impact on health ranging from mild sleep disturbances to increased rates of certain rare cancers and health conditions that mimic neurological illness and Lyme disease. How high is your exposure? Review this checklist for easy ways to reduce your daily exposure.