The Body Cleansing and Rejuvenating Clinic

The Clinic and its Treatments

Treatments at the Clinic are intended for Clients

experiencing a very wide range of Physical or

Stress related problems and want help and

support in recovering from or alleviating them.

Usually this involves more than one of the

following Therapies - Colonic Hydrotherapy,

Professional Nutritional Advice, Herbs and

Supplements, Bio‑resonance and Deep Tissue

Massage - all designed to achieve a worthwhile

improvement in health.

I try to ensure that clients feel they are the only

person who matters when I am treating them and

they are always given all the time needed.

However I do ask clients not to arrive late,

because if they do the whole day from then

onwards is sure to run late. So please try to arrive

a little early; there is always traffic congestion at

some unexpected places and trains do run late. If

you assume that everything will be smooth on

your journey you will be sure to be late arriving.

One of my objectives is to teach clients who

have been to me for a full investigation and in-

depth consultation to look after their health

themselves. I encourage such established clients

to telephone me if they have a problem - no fee

is charged for this.

I have a substantial range of bio-resonance (Vega

and Avatar) equipment that I use for general

Diagnostic Testing and for specific testing for

matters such as allergies, food, chemical and

heavy metal intolerances, mineral and vitamin

deficiencies and mercury toxicity and also for the

treatment of a very wide range of health

problems. If you wish to give up smoking or any

other addiction, Bio-resonance therapy has been

shown to be very effective. All the testing is non-

intrusive.

Experience is that the time required for

consultation, testing, treatment and advice

involving bio-resonance equipment (referred to

in the previous paragraph) varies considerably

from client to client so my fees are based on

time. A typical fee for Allergy Testing is £120.

For appointments on a Saturday or at 5.00pm or

later on a weekday all fees are increased by 10%.

Continued on the next page

BCRC Page 1

Tel: 020 8679 6119 Fax: 020 8679 6292

Email: bcrc@saqnet.co.uk

www.colon-clinic.co.uk

15 Westwell Road

Streatham

London

SW16 5RU

UK

Page Index General information about the Clinic and its treatments, preparing

yourself for your first appointment, public transport, car parking and fees

Colonic Hydrotherapy

Matrix Regeneration Therapy and VEGASOM equipment for treating a

very wide range of problems

Wholistic Questionnaire - I will send you a copy for completion before

you come for the first time

This page & page 2

Pages 3 to 6

Pages 7 to 10

Pages 11 to14

If you come to the Clinic for the first time for

consultation, treatment or to buy supplements you

will be tested on diagnostic equipment. No new

Client will be supplied with supplements without a

consultation (for which a fee will be charged). So

as to ensure the reliability of the results please:

(1) for 48 hours preceding the appointment, do

not take any strong medication (sleeping

pills, tranquillisers, psychopharmaceutical

products, antibiotics, cortisone preparations

etc). Medication which cannot be interrupted

should, naturally, be continued but please let

me know before the test;

(2) on the day of the appointment please do not

drink any coffee, tea or alcohol;

(3) on the day of the appointment do not smoke,

do not take a cold bath or cold shower, do not

use any body sprays, any creams, oils or

ointments;

Please wear loose, comfortable clothing.

I advise all new clients to:

(a) eat meals regularly in the days before they

come to the Clinic for their first treatment;

(b) drink at least 2 litres (8 full glasses) of water

every day before coming in for the first

time;

(c) make sure that they do NOT arrive at the

Clinic hungry or immediately after a heavy

meal.

Credit Cards are welcomed.

The Clinic is close to Streatham Common & within a short walk of:

(a) Streatham Common NR station (Victoria 15 mins, Clapham Junction 10 mins, Balham on the Northern Line 4 mins, East & West Croydon 10 mins ) and: (b Streatham NR station (London Bridge, Blackfriars, Farringdon, Kings Cross & West Hampstead via Thameslink). There are frequent buses from Brixton tube station on the Victoria Line, Croydon and from both the West and the East.

Free on-street car parking is always available.

Professional Fees

Colonic Hydrotherapy

Weekday before 5.00pm £70.00

Weekday 5.00pm or later &

all day Saturdays £77.00

Bacterial Implants (optional) £7.50

Seven Day Cleanses £590.00

Any supplements clients may elect to have

are extra.

Please do NOT arrive at the Clinic

hungry.

Massage Weekdays before 5.00pm from £35.00

Weekday 5.00pm or later &

all day Saturdays from £38.50

Diagnostic Testing, Bio -resonance Treatments, In–depth Consultations and Nutritional Advice

Fees are based on the time involved which will vary from Client to Client. Typically a daytime weekday consultation fee is £87.00 & Vega treatment from £45.00. Time based fees are increased by 10% for weekday appointments at 5.00pm or later & for all Saturday appointments

BCRC Page 2

The Body Cleansing

and

Rejuvenating Clinic

Health

Improvement

with the help of

COLONIC

HYDROTHERAPY

THE COLON

The colon, or large intestine, is an important

part of the digestive system; some 5 feet in

length and 2.5 inches in diameter, situated at

the end of the alimentary canal, it completes

the digestive process and handles our food

waste and much other body waste. It is

normally populated by billions of friendly

bacteria which assist in detoxifying waste,

synthesise certain vitamins and help us guard

against infection. These same bacteria make

up some 70% of the dry weight of our faecal

waste. The colon structure is of smooth

muscle and it is broadly divided into 3

segments; the caecum and ascending colon

into which food waste enters in a fluid state

through the ileo-caecal valve, the transverse

colon where water, minerals and vitamins are

re-absorbed and the descending colon where

mucus is secreted to coat the faeces prior to

defecation through the rectum and anus.

In health, bowel transit time from eating to

defecation is 24 hours or less and bowel

movement is at least once daily. In disease,

poor digestion, yeast overgrowth, spastic

colon, irritable bowel syndrome, chronic

constipation and diarrhoea are usually

accompanied by auto-intoxication, literally,

"self-poisoning' - the re-absorption of soluble

wastes into the bloodstream - which places a

heavy burden upon the other eliminative

organs of the body, the kidneys, the skin and

the lungs.

Chronic constipation can lead to further direct

complications: diverticulitis, haemorrhoids,

fissures, atonicity, spasticity, prolapsis, colitis

and even bowel cancer as well as chronic

toxic conditions in the rest of the body, like

the skin (e.g. acne and eczema), the

cardiovascular system, the nervous system

and the liver.

Correct function of the colon is a necessity

for health, for truly 'disease can begin in the

colon'. It has been said that colon

malfunction can lead to 80% of all diseased

states.

BCRC Page 3

At the BCRC, Colonic

Hydrotherapy is often

combined with

Professional Nutritional

Advice. It frequently forms

part of an integrated

programme involving

Diagnostic Testing and

Treatment with a range of

Bio-resonance Equipment,

often Nutritional

Supplements and a variety

of Massages including

Deep Tissue all designed to

achieve a

worthwhile improvement

in health.

A Healthy Colon

Why Colonic

Hydrotherapy?

Poor elimination can lead to many chronic

conditions; it is these very conditions that

colonic hydrotherapy can help: Constipation

- Diarrhoea Mucus colitis - Colitis - Spastic

Colon Diverticulitis - Liver sluggishness -

Halitosis - Headaches - Flatulence -

Haemorrhoids - Skin problems (acne, eczema

and psoriasis) - Abdominal bloating -

Asthma - Allergies - Fatigue - many

'Psychological' states such as depression,

lethargy, schizophrenia, etc. It is also of

benefit prior to and following barium enemas

and during therapeutic fasting Some complex

conditions such as Crohn's disease, Myalgic

encephalomyelitis (M.E.) and intestinal

Candida are also helped by the resultant

detoxifying effect of colonic hydrotherapy.

What is involved?

Filtered water at a carefully regulated

temperature is introduced under gentle

gravitational pressure through the rectum

into the colon. With special massage

techniques, the water begins to soften and

cleanse the colon of faecal matter and old

deposits which are piped away with the

waste water. The therapist works

progressively around the structure of the

colon allowing water alternately to flow in

and release. Before having Colonic

Hydrotherapy for the first time at this Clinic,

the Client takes a Diagnostic Test to check

that Colonic treatment is appropriate for

them.. Taking this test adds 20 minutes to the

normal appointment time. for Colonic

treatment. If the results of the test suggest

that an In-depth Consultation is advisable

this can be arranged for a subsequent

appointment.

What is Colonic

Hydrotherapy?

Colonic hydrotherapy is an internal bath that

helps cleanse the colon of poisons, gas,

accumulated faecal matter and mucus

deposits. Such techniques were first

recorded in 1500 BC and have been used in

traditional and naturopathic medicine since

that time. Using sterilised equipment,

filtered water is gently introduced into the

rectum which progressively softens and

expels faecal matter and compacted deposits.

Colonic Hydrotherapy is much more

effective than an enema, since the whole

colon is treated and water is not purposely

retained. It is best used as a complementary

technique to other therapies. By improving

elimination, response to dietary,

homoeopathic, herbal, manipulative and

other therapies is markedly improved.

Is any preparation required?

All new clients are advised to:

(1) eat meals regularly in the days before they come to the Clinic for their first treatment;

(2) drink at least 2 litres (8 full glasses) of water every day before coming in for the first time;

(3) make sure that they do NOT arrive at the Clinic hungry or immediately after a heavy meal.

BCRC Page 4

Is it safe?

Yes. Equipment is disposable or sterilised

using hospital approved sterilisation solutions

which kill all prevalent bacteria, viruses and

fungi in minutes. Countless thousands of

colonics have been given safely; the water

pressure is very low, so there is no danger of

bowel perforation and the water used is pre-

filtered.

Unlike regular use of laxatives, colonic

hydrotherapy is not habit-forming, and in fact

improves colon muscle tone.

The Association of Colon Hydrotherapists

maintains high standards of qualification for

its registered therapists

And the results ....

Most people quickly experience improved

mental clarity after colonic hydrotherapy. With

their toxic load diminished and elimination

improved, a greater feeling of well-being and

lightness is felt.

There is obvious relief from bloating and

constipation, toxic headaches, painful

haemorrhoids and skin problems. In the

longer term, bowel disease risk is also

diminished and nutrients are better absorbed

leading to improved all-round health.

Who can benefit from

Colonics?

Essentially anyone with a condition

aggravated or caused totally or in part by

autotoxicity, and where the resulting improved

elimination aids healing. Most diets include

mucus-forming foods like dairy eggs, sugar,

flour, and tofu and even those people on

relatively good diets and who have regular

bowel movements have old hardened

accumulations of mucoid deposits which

hinder proper elimination and need periodic

cleansing.

How many treatments?

Human bodies vary greatly and it suggested

that a new Client books for their first

treatment only. During the first appointment

the Client will be given advice. At the end of

the first appointment the new Client may then

decide what further treatment, if any, they

want. However, deposits built up over a

lifetime cannot be shifted with one or two

irrigations only. It is a good idea to have a

treatment every 3 to 6 months to maintain

inner cleanliness and good elimination but

again this will vary from Client to Client.

Implants of friendly bacteria are normally

advisable after treatment. The modesty of the

Client is maintained throughout the treatment.

The Association and Register of Colon

Hydrotherapists (formerly the Colonic

International Association) was founded in

1987 by Dr. M. Siewert, an experienced

Medical practitioner and Chiropractor, now

specialising in enterotoxicity and

detoxification. The Association aims to

maintain a high standard of practise and

training in colonic hydrotherapy and to care

for the patient.

For information about Bacterial

Implants please see next page.

BCRC Page 5

BACTERIAL IMPLANTS are advised after Colonic

Hydrotherapy treatment

Each Bacterial Implant contains B. bifidum, B. longum, L. acidophilus &

L. casei. Following Colonic Hydrotherapy the bowel is denuded of its

complement of essential bacteria which needs to be replaced rapidly so as to

reduce the possibility of opportunistic infestation by Candida albicans &

other unfriendly bacteria. Implants provide active live bacteria that normally

reside in the healthy colon. The bacteria are essential if the normal bowel

function is to be maintained & opportunistic bacteria & yeast organisms are

to be controlled.

L. acidophilus and B. bifidum are both resident organisms found in the

human intestinal tract & modern day diets, stress & antibiotic therapy can all

have an impact on these sensitive organisms.

L. acidophilus may lessen the proliferation of yeast organisms such as

Candida albicans in the intestinal tract. It also helps to reduce unfriendly

bacteria by producing natural antibiotic substances 'on site' on the intestinal

wall.

Bifidobacterium helps to reduce opportunistic bacteria & the absorption of

protonated amines. In addition it helps with lipid metabolism & in the

reduction of available cholesterol in the diet.

L. casei & B. longum are transitory organisms that exert a positive influence

on intestinal pH.

SUPPLEMENTS

Supplements will not be supplied to anyone who is not a Client of the Clinic and has undergone a Consultation for which a fee has been charged.

BCRC Page 6

Vega Check test report

VEGA Equipment The Clinic has a complete range of VEGA equipment, developed and manufactured by VEGA Grieshaber KG in Germany some of which is used for testing and to help with diagnosis and some used for therapeutic purposes. The next 3 pages deal specifically with just two of the pieces of the therapeutic equipment - the Matrix Regeneration Therapy (MRT) equipment and the VEGASOM. MRT is an excellent preparation for subsequent follow up therapy for almost all chronic diseases examples of which are: Rheumatic diseases Chronic inflammation (wounds) Bronchial Asthma Allergies Skin diseases Lymphostasis (blockage of normal lymph flow) Degenerative diseases (spinal column & joints) MRT helps the essential detoxification process when the body is unable to do this unassisted.

Although normally MRT is recommended initially at weekly intervals for 6 to 8 weeks it is not unusual for people experience an improvement after even only one treatment.

VEGASOM treatment has proved successful, often in conjunction with other treatment in treating: Depression Stress Anxiety A wide range of physical problems such as bronchial asthma, acne, eczema, stuttering. Chronic diseases are on the increase, all too often exhibiting new and relatively unknown symptoms. There are an enormous number of new chemical compounds which, to a large degree, wind up in being incorporated into our bodies. Today, everyone is thus polluted to a greater or lesser extent with these substances, whether or not they experience symptoms of illness. Practitioners are seeing an increase in psychic problems and VEGASOM treatment is particularly useful in the treatment of diseases with a psychosomatic component.

BCRC Page 7

MRT on its Trolley

THE VEGASOM

Matrix Regeneration Therapy has 3 components working in parallel The Petechial Vacuum Extraction Massage creates a partial vacuum in the tissue (normally of the back). Used up blood laden with toxins is drawn to the surface where it is removed via the lymphatic system. In the case of previously damaged tissue, this can actually cause hematomas (bleeding on the surface). Initially the intense red streaks on the skin may be visible for days. After a number of treatments - and as tissue continues to regenerate (it gets noticeably firmer) - these streaks fade after a few minutes and the pain sensitivity also abates more and more. The MRT’s effectiveness is not based just on mechanical tissue cleansing but, in a special way, on two other energetic components. The suctioned-up toxins and waste by-products can be regarded as electro-magnetic information with a pathological vibrational pattern. Using Systems Information Therapy, a further development of bio-resonance therapy, the organisation’s underlying disturbance fields can be neutralized, taking a considerable load off the immune system. A visible consequence of this is that disease conditioned muscular tension eases up during the course of treatment. Although the therapy is primarily performed on the back, all internal organs are accessed via neural reflex zones thus achieving a very deep effect. The third component is low intensity Direct Current Treatment that re-polarizes diseased tissue in order to stimulate regeneration whereby existing charge deficits are compensated out.

MRT All three components work together towards synergistically reinforcing each others’ effects. The effects achieved by using MRT far transcend those described above. Each treatment strongly stimulated the immune system to greater defensive readiness. Also hematopoiesis (the formation of blood cells) and the lymphatic system are intensely stimulated. Chronis mal-position of the spinal column due to muscular tension, as well as blockages that impede the flow of energy in the body can be relieved - and the stress overload on the brain’s central hormonal regulatory system vanishes. Thus a single operation performs a comprehensive whole-body-orientated treatment

BCRC Page 8

Petechial Vacuum Extraction

Massage

The MRT uses a suction

electrode to generate a partial

vacuum in tissue. Worn-out and

toxin laden blood is drawn to

the surface. Consequently the

suction electrode is an ideal

input electrode for recording

pathological frequency patterns

to be used in System

Information Therapy.

The matrix is the organism’s

basal system comprising about

80% of the total cell mass. It is

the supply and waste-disposal

system of the organ cells as well

as the home of the body’s

defences. Because of its central

importance for health, it is,

when fighting disease, the main

attack point of any effective

therapy.

Direct Current Treatment

A crucial part of the therapeutic

effect of MRT involves the

matrix’s charge state and

hormonal situation. A weak

electric current is introduced into

the tissue behind a roller

electrode which shunts off excess

charge from diseased tissue. The

repolarized tissue becomes

alkaline again - a precondition

for normal metabolic function.

System Information Therapy

T h e n e u t r a l i z a t i o n o f

pathological energy fields is the

domain of System Information

Therapy, a further development

of bio-resonance therapy. Via

the suction electrode toxin

information is detected and

transmitted to the control unit

for processing when these

pathological frequency patterns

are transformed into therapeutic

signals and routed back to the

patient.

Self healing powers can thus be

activated by means of

resonance effects and the

healing process initiated.

BCRC Page 9

VEGASOM VEGASOM Therapy works by ”re-normalising” brain wave patterns that have gone “askew”. A study at the University of Freiburg showed that induction therapy with the aid of the VEGASOM is not stressful to patients and to the extent that the patient is receptive to the treatment it stimulates the brain. Experiments have shown that if the Client rejects being treated with the induction specific frequencies then no benefit is achieved. Hence an appreciable proportion of Clients will not benefit from the therapy—nor will they be harmed by it. In such cases alternative or additional therapies will be used to achieve results. Experiments at the International Institute for Psychosomatic Medicine in Prague on 81 patients showed that the VEGASOM can be used for a broad range of modern “diseases of civilisation” which have a psychic aspect. The therapy helped in cases when conventional treatment had not been of use. Many of the patients noticed a therapeutic effect after the very first treatment. The problems faced by the 81 patients are shown in the graph below.

The VEGASOM induces brain wave frequencies with the aid of micro-currents in order to treat psychosomatic disorders. With the aid of standard programs the practitioner can call up particular therapy programs which are associated with specific problems. The results of the treatment of the 81 patients are shown in the pie charts below. Overall 83% of the patients benefited (and, of course 17% did not) and 53% ended treatment cured. Results were particularly good for those suffering from depression or stress where those cured were 72% and 68% respectively

Depression No success 14%

Improvement 14% No complaint 72%

No success 13%

Improvement 19%

Stress

No complaint 68%

Overall healing success with VEGASOM

No improvement 17%

Improvement 30% No complaints 53%

Healing 83%

Patient complaint

epilepsie

tic-neurosis

stuttering

dysmenorrhea

bronch. asthma

migraine

enuresis noct.

acne

eczema

stress

depression

Patient

numbers

BCRC Page 10

The Body Cleansing and Rejuvenating Clinic Please complete this and return to:

Tel: 020-8679-6119 BCRC

E-mail bcrc@saqnet.co.uk 9H 15 Westwell Road

fax 020-8679-6292 LONDON

http://www.colon-clinic.co.uk SW16 5RU

UK

WHOLISTIC QUESTIONNAIRE If you already have an appointment please state date ……………………& time ……… Please use separate sheets of paper if you find insufficient room on this questionnaire. Add any further

information you think it would be helpful for me to know. Completion of this questionnaire in no way

commits you to coming on the programme but if you do arrange an appointment you must undertake to give at

least a full 48 normal weekday hours (i.e. excluding Saturdays, Sundays and Bank Holidays) notice of a

cancellation to avoid being invoiced for the full fee. Please sign & date on page 4

NAME ...................................................................... ………………………………………………

Email ……………………………………………………………………………………………….

HOME ADDRESS .................................................................................................................................

..........................................................................................................................................................

TELEPHONE HOME .................................WORK ................................MOBILE ………………..

OCCUPATION ............................................................... . DATE OF BIRTH .......................

HEIGHT ......................... WEIGHT ........................... MARITAL STATUS ...................

ARE YOU UNDER A DOCTOR'S CARE? ......... IF YES, PLEASE GIVE DETAILS .................

..........................................................................................................................................................

DOCTOR'S NAME .............................................................. TELEPHONE ............................

DO YOU HAVE ANY SERIOUS HEART, LIVER OR KIDNEY COMPLAINTS? .......................

IF YES, PLEASE GIVE DETAILS .................................................................................................

ANY OTHER MAJOR PHYSICAL COMPLAINTS? .....................................................................

..........................................................................................................................................................

PLEASE LIST ANY SURGERY YOU HAVE HAD ......................................................................

..........................................................................................................................................................

DO YOU HAVE ANY TUMOURS OR GROWTHS? ...... IF SO, PLEASE GIVE DETAILS

..........................................................................................................................................................

BCRC Page 11 Partners: Jean Clarke LCSP(Phys), DHD, MACH, RT & Brian T Collins FICE, FRTPI, FCILT, FCMI, MIStructE

ARE YOU DIABETIC? .............. ARE YOU PREGNANT? .................

PLEASE LIST ALL MEDICATION & SUPPLEMENTS YOU NOW TAKE REGULARLY

(including over the counter medication)

...............................................................................

..........................................................................................................................................................

PLEASE LIST ALL KNOWN ALLERGIES ...................................................................................

..........................................................................................................................................................

HAVE YOU HAD COLONIC HYDROTHERAPY? ......... IF YES, WHEN LAST? .....…....

HAVE YOU CONSULTED A NUTRITIONIST RECENTLY? .............. IF YES. WHY? .........

..........................................................................................................................................................

HOW MANY BOWEL MOVEMENTS PER DAY DO YOU USUALLY HAVE? ........

DO YOU NORMALLY HAVE TO STRAIN TO HAVE A BOWEL MOVEMENT? .....................

DO YOU USE A STOOL SOFTENER OR LAXATIVE? ........ HERBAL LAXATIVE? ........

SUPPOSITORY? ........

DO YOU HAVE HAEMORRHOIDS OR OTHER RECTAL PROBLEMS? ...........

HAVE YOU EVER HAD RECTAL BLEEDING? ......... IF YES, WHEN? ...................

HAVE YOU EVER HAD BLEEDING FROM ANY OTHER BODILY ORIFICES? .........

IF YES, PLEASE GIVE DETAILS .................................................................................................

HAVE YOU EVER HAD A BARIUM ENEMA? ............ IF YES, WHEN? .....................

TO GIVE ME AN IDEA OF YOUR GENETIC HEALTH PROFILE PLEASE LIST ANY

HEALTH PROBLEMS THAT HAVE AFFECTED YOUR:

MATERNAL GRANDMOTHER .....................................................................................................

MATERNAL GRANDFATHER ......................................................................................................

PATERNAL GRANDMOTHER ......................................................................................................

PATERNAL GRANDFATHER ........................................................................................................

MOTHER .........................................................................................................................................

FATHER ..........................................................................................................................................

SISTERS ..........................................................................................................................................

BROTHERS .....................................................................................................................................

BCRC Page 12

HOW MANY CHILDREN DID YOUR PARENTS HAVE? ...... WHAT WAS YOUR

BIRTH POSITION IN THE FAMILY? ...........................................................................................

WERE YOU BREAST FED AS A BABY? .....................................................................................

IF YOU ARE FEMALE, DO YOU HAVE ANY CHILDREN? ......... IF YES, HOW MANY? ......

HOW FAR APART WERE THEY BORN? ...............................................................

PLEASE LIST THE FOODS AND DRINKS YOU WOULD HAVE ON A NORMAL DAY.

BEGIN WITH FIRST THING YOU HAVE IN THE MORNING THROUGH TO THE LAST

THING AT NIGHT. IT IS IMPORTANT THAT YOU LIST ALL FOODS AND DRINK IN

EACH MEAL AND BETWEEN MEALS. WHEN YOU DESCRIBE YOUR DRINKS PLEASE

STATE EXACTLY WHAT THEY ARE AND WHAT YOU ADD TO THEM, IF ANYTHING.

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What do you hope to achieve by having treatment at the Clinic?

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BCRC Page 13

PLEASE TICK [] ANY PRESENT CONDITIONS

CROSS [×] ANY PAST CONDITIONS YOU NO LONGER HAVE

LEAVE BLANK CONDITIONS YOU HAVE NOT EXPERIENCED

Blurred vision

Hoarseness frequent

Burning feet

Falling hair excessive

Breathing irregular

Itching feet and/or skin

Eat when nervous

Bitter metallic taste in mouth

in morning

Dry eyes, mouth & nose

Eyelids swollen & puffy

Eyes or nose watery

Difficulty in remembering

Sneezing attacks

Moods of depression

Worried, feel insecure

Irritable before meals

Faintness when meals

delayed

Coated tongue

Cannot get thoughts out of

head

Frequent nose bleeds

Nightmare type dreams

Noises in head or ears

Keyed up

Susceptible to colds

Afternoon headaches

Get drowsy often

Cannot get to sleep

Bad breath (halitosis)

Crave candy or coffee

Fever easily raised

Sigh frequently, 'air hunger'

Perspire easily

Pressure in pit of stomach

Extremities cold & clammy

Heart pounds after retiring

Hands & feet go to sleep

easily, numbness

Greasy food upsets

Pain between shoulder

blades

History of gall bladder

problems

Overeating of sweets upsets

History of gallstones

Acid food upsets

Indigestion ½ to 1 hour after

meals or up to 3-4 hours later

Wake up after a few hours

sleep & hard to get back to

sleep

Difficulty swallowing

Milk products distress

Dull pain in chest & left arm

Stomach bloating after meals

Sour stomach frequently

Circulation poor

Tension under rib cage

Pulse speeds up after meals

Digestion difficult

'Butterfly' stomach, cramps

Indigestion soon after meals

Aware of 'breathing heavily'

Biliousness

Heart palpitates if meals

missed or delayed

Constipation / diarrhoea

alternate

Mucus colitis

Nervous' stomach

Susceptible to colds, asthma,

bronchitis

Stools light in colour

Sensitive to hot weather

Lose taste for meals

Excessive appetite

Get 'shaky' if hungry

Vomiting frequently

Pulse slow, irregular

Gag easily

Shortness of breath

Gas shortly after eating

Appetite reduced

Neuralgia like pain

Bowel movements painful and

difficult

Loss of leg energy

Muscle/leg/toe cramps at night

Swollen ankles

Lower bowel gas a few hours

after eating

Skin peels on feet

Stools alternate soft / watery

Urine amount reduced

Muscle cramps worse during

exercise, get 'Charley horses'

Frequent urination

Stool has foul odour

Burning or itching anus

Dizziness

Dry skin

Skin rashes frequent

Hungry between meals

Fatigue relieved by eating

Joint stiffness after getting up

Do you need to open windows

in a closed room

Strong light irritates

Cold sweats often

Bruise easily, 'black & blue'

spots

Burning stomach sensations

...................................................

Signed

Date ……………………..…..

NOTE To supplement the information

given by your completed

Questionnaire normally you will

be tested on diagnostic equipment.

So as to ensure the reliability of

the results please: (1) for 48

hours preceding the

appointment, do not take any

strong medication (sleeping pills,

tranquillisers,

psychopharmaceutical products,

antibiotics, cortisone

preparations etc.). Medication

which cannot be interrupted should

naturally be continued but please

let me know before the test;

(2) on the day of the

appointment please do not drink

any coffee, tea or alcohol;

(3) on the day of the

appointment do not smoke, do

not take a cold bath or cold

shower, do not use any body

sprays, any creams, oils or

ointments;

(4) please wear loose,

comfortable clothing

BCRC Page 14