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🌟 3D Healing Nutrition Assessment

Multivitamin Needs Evaluation

3Dhealing.com

📋 Directions

This questionnaire asks you to assess how you have been feeling during the last six months. Please take all the time you need to complete this questionnaire.

For each question, select the number that best describes your symptoms:

0 = Rarely or No Almost never occurs
1 = Occasionally 1-2 times a month
2 = Often 1-2 times per week
3 = Frequently or Yes 4+ times per week
Complete all questions to see your results
0%
📊 Section 1a: Macronutrient/Diet Assessment
Score: 0
Alcohol
Soda/carbonated beverages
Artificial sweeteners
Eggs
Boxed/Prepared Foods
Dairy
Fast foods
Red meats
Deli Meats
Desserts
Frozen meals
💊 Section 1b: Vitamin Support
Score: 0
Dry eyes, Dry skin, or dandruff
Cracking in the corners of the mouth or the lips
Swollen tongue, bad taste in the mouth
Numbness, tingling, or itching of hands or feet
Worry, anxiety/nervousness, or depressed
Poor memory or concentration
Rapid heart rate
Excessive thirst, sweating, or Night sweats
Don't remember dreams or MSG sensitivity
Decreased night vision
Bleeding gums, Bruise easily, or Nose bleeds
Fatigued easily
Sunburn easily
Crave fatty foods
Teeth Grinding
Pale Skin
Hair loss and weak or brittle nails
⚗️ Section 1c: Mineral Support
Score: 0
Leg, Calf, foot, cramps at rest
Tight muscles that may return shortly after massage or stretching
Trouble sleeping and constipated
Joints and muscles are very flexible
Joints pop and click
Get sick easily or heal slowly
White spots on fingernails
Decreased sense of taste or smell
Feel sluggish, foggy thinking with muscle weakness
Feet have a strong odor
Changes in heart rhythm or rate and muscle spasms
Sweat excessively
Dry skin and slow wound healing
Trouble swallowing with hoarseness and weight gain

Your Nutritional Assessment Results

Diet Assessment

0

Vitamin Support

0

Mineral Support

0

Total Score

0