Questionnaire

Last updated: Sep 25, 2009

Before you begin...

	If you wish to remain completely anonymous, you may use a false name and any (working) e-mail address.  The e-mail address must be valid since that is how we send your report. Also, if making payment under some other name than on your report, and you don't think we will make the connection, you could email us by using the 'Contact us' link at the top right of this page and let us know so that we can apply the payment to the correct record.
	Your report can be password-protected so that no one else can read it.
	Please make sure to register the address doctor@digitalnaturopath.com with your email program so that our email to you won't be lost in the spambox or trash.

NOTICE: If you have already begun the questionnaire click here to login and continue. There is no need to re-enter the information below.

NONE of this information will EVER be given to third parties.
Items marked '*' are mandatory.

Your name: * First, Middle Initial(s), Last
Date of birth: * MM-DD-YYYY
Sex: *	Male   Female
Your e-mail address: * Please check it carefully!	You will have the option to receive a password-protected report so that only you can read it.
Re-enter e-mail address: * For accuracy!	All correspondence will be sent to this email address. You will receive a Welcome email shortly. Please add the sender to your 'safe recipients' list so that you will recieve your health report when it is ready.
Password: * 6 or more characters	The password will enable you to re-enter the site and resume answering questions should you become disconnected. We will send you an email once you begin the questionnaire that will include the userid and password you enter here. If for some reason you lose your password, click on Contact Us above.
Please re-enter password: *
Coupon:	Please enter exactly as shown.

CUSTOMIZE YOUR REPORT The report that you receive will be very detailed.  In order to keep its size down to a minimum, you may wish to select only those options below that are of interest to you. (These options also determine which questions you will be asked.)	Include
Conditions that you are already aware of Would you like to read what we have to say about conditions that you tell us you have? This should always be checked unless you are certain you DO NOT wish to receive information on conditions of which you may already be aware.
Metabolic Typing Would you like custom diet and nutrient recommendations based upon our calculations of your metabolic type?
Recommendations based on your blood type Would you like to see information based upon the book by Peter D'Adamo, ND?
Ayurvedic Typing Would you like some very basic recommendations based on this 4,000 year-old traditional Indian system?