"SCD" COUNSELING:  

   FFor Kay's one-on-one counseling services:    

Copy and paste the following "Questionnaire" into an email,

answer the questions, and send to: 

kstence@marykay.com 

Kay will review your completed "Questionnaire" and

call you with plan and payment options using 

PayPal, Visa, Master Card, or Discover.

Call Kay:  (512) 632-3682   

_______________________________________________

Name:                                         Date:                  Phone:                          Age:

Address:                                                                Email:

Are you male or female?                                      How many people live with you?

How did you find my website?

What have you been diagnosed with?

Do you suffer from weakness, muscle or joint pain, swelling, tingling or numbness?

Do you have poor circulation?                           Do you itch often?

Do you suffer from headaches, bronchitis, asthma or allergies?

Do you feel worse when exposed to mold, dust, chemicals or pollutants?

Do you suffer from rashes, athlete’s foot, jock itch or yeast infections?

Do you feel worse when deprived of sugars and carbohydrates (potatoes, bread, sweets)?

What foods are you sensitive to?

What are your symptoms/reactions?

What foods have you eliminated from your diet?

For how long?

Do you like to cook?

Do you make the SCD 24-hr lactose-free yogurt?

Do you suffer from indigestion or acid reflux?

Does your esophagus make “gurgling” sounds?

Do you cough after eating or drinking?

Do you suffer from indigestion, gas, bloating, diarrhea or constipation?

How many bowel movements do you have daily?

Are they formed?                                                   Do they pass easily?

Which color: Yellow, grey, brown or black?

Do you have abdominal soreness?

Do you have heart pains or palpitations?

Do you have gynecological disorders: PMS; irregular, painful or no menstrual cycles; hot flashes?

For what conditions do you take prescription drugs?

How often do you take antibiotics?

What supplements/herbs/medications do you take?

How often do you wake during the night?

Do you have leg/foot/toe cramps or restless legs at night?

On a scale of 1-10, how do you feel when you wake in the mornings (1 being great & 10 being awful)?

Do you feel alert or foggy-brained during the day?

Do you have unusual bouts of depression, anger or irritability?

Are you overweight or underweight?

Have you been diagnosed with an autoimmune disease?

When was your last colonoscopy and/or endoscopy?

Have you had any abdominal surgeries?

Do your parents or children suffer with digestive/intestinal/bowel or malabsorption problems?

Do you feel “hopeful” or “hopeless” about your health and/or disease?

Do you need help quickly with anything?

Would you like to be on my email list for future announcements?

THANK YOU!

      Kay Stence, SCD Digestive Health Counselor 

Certified Nutrition & Lifestyle Coach  

www.nuturing-lifestyle.com

    www.wwww

1863 Greenwood Lane 

 Kingsland, TX 78639    

 512-632-3682