Parasite Questionnaire

Parasite nike revolution 7 Questionnaire

Name

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Date

TRAVEL

Have you had gut issues, unexplained fever, high white cell blood count and night sweats during or since travelling overseas?

Do you frequently swim in fresh water streams, lakes or ponds while overseas?

Have you ever travelled to such countries as Africa, Russia, Asia, Mexico, China, Middle East, or to Central or South America?

Did you serve abroad while in the military?

Have you ever travelled to such tropical islands as the Carribbean, Bahamas or Hawaii?

Were you a prisoner of war in Vietnam or World War II

WATER

Have you ever drunk from fresh water streams, lakes, or rivers while on camping or hiking trips, without filtering or boiling it first?

Do you drink untested well water

Do you use regular, unfiltered tap water for enemas or colonics?

Do you use regular, unfiltered tap water to clean your contact lenses?

Is your water supply from a mountainous region?

Can you trace the onset of symptoms, such as intermittent diarrhoea and constipation, muscles aches and pains, night sweats, unexplained eye ulcers, to any of the above?

FOOD

Do you preferably eat your meat or fish rare or medium rare?

Do you eat smoked or pickled foods, such as herring, smoked salmon, sausages?

Do you cook your beef, fish or pork in the microwave (as opposed to reheating them)?

Do you regularly eat raw vegetable salads, and eat raw fruit unpeeled?

Do you frequently eat raw fish dises such as sushi and sashimi, Latin Americal ceviche or Dutch green herring?

Do you often eat pork hot dogs?

Do you prepare gefilte fish at home and taste test as you go?

Do you use the same cutting board for meat, chicken and fish as you do for vegetables?

Do you enjoy such raw meat dishes as steak tartare, Middle Eastern kibbe or Italian carpaccio?

Can you trace the onset of such symptoms as weight loss, distended belly, bloating and anaemia to any of the above?

PETS

Do you have a pet at home?

Have you gotten a puppy lately?

Do you clean the cat litter box?

Do you keep your pets in your yard where your children play/

Do you or your children forget to wah your hands after petting or cleaning up after your pets, and before eating?

Do your pets eat from your plates?

Do your pets sleep in your bed with you?

Do you frequently handle pets - either at home or at work?

Can you trace such symptoms as distended belly in children, unexplained fever, abdominal pain, or high white cell blood count to any of the above?

WORKPLACE

Do you work in a day-care centre?

Do you work with or around animals?

Do you work in sanitation?

Do you work in a hospital?

Do you work or garden in a yard to which dogs and cats have access?

Do you work in a pet shop, zoo, or experimental laboratory?

Are you a vet or work in a veterinary clinic?

Can you trace any gut issues to any of the above?

SEXUAL PRACTICES

Have you had sexual relations with an individual born overseas?

Do you engage in oral sex?

Do you engage in anal intercourse without using a condom?

Can you trace the onset of such symptoms as persistent reproductive organ issues, to any of the above?

MAJOR SYMPTOMS - ADULTS (Be mindful that the following symptoms can also be associated with other illnesses)

Do you have dark circles under and around your eyes?

Do you grind or clench your teeth?

Do you have a history of allergies?

Is your tummy distended despite what you eat?

Do you have a bluish cast around your lips?

Do you suffer from chronic constipation, intermittent constipation or diarrhoea or intermittent hard or loose stools?

Are you suffering from loss of appetite, moodiness, depression, weight loss or weight gain, sugar cravings, disorientation or lethargy?

MAJOR SYMPTOMS - CHILDREN (Be mindful that the following symptoms can also be associated with other illnesses)

Is your child restless at night?

Does your child have dark circles under or around their eyes?

Does your child have a habit of eating dirt?

Does your child tear his/her hair out?

Is your child overactive?

Does your child clench or grind his/her teeth at night?

Has your child been diagosed with "failure to thrive"?

Does your child cry frequently or for no apparent reasons?

Does your child constantly pick his nose?

Does you child have an itchy bum or scratch it frequently?

Does your child wet the bed often?

Does your child suffer from a limp that orthopaedic treatment has not helped?

Does your child have bleeding gums, blood noses or has a tendency to bleed from the rectum?

Is your child sensitive to light and prone to blinking frequently, squinting or eyelid twitching?

Does your child suffer from recurring headaches?

Does your child have a brassy staccato-type cough?

Does your child suffer convulsions, or an abnormal electroencephalogram (EEG)?

MAJOR SYMPTOMS - INFANTS (Be mindful that the following symptoms can also be associated with other illnesses)

Is your baby a chronic crier?

Does your baby suffer from severe intermittent colic?

Does your baby exhibit a blotchy rash around the perianal region?

Does your baby frequently bang his/her head against the cot?

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