Retest Form

Prior to sending in your retest hair sample, please complete this form in its entirety. We know it can be embarrassing, but an accurate description of your adherence to each program area will allow us best tailor your new protocol and follow-up appointment.

Name *
Name
Address *
Address
How closely have you been following your program? *
How closely have you been following your program?
I follow the diet strictly.
I drink 3 quarts of spring water per day.
I do daily coffee enemas.
I do my recommended sauna therapy.
I brush my skin when i shower.
I go to bed by 9 pm most nights.
I meditate with the pushing down exercise.
I take the supplements as indicated.
I do foot reflexology daily.
I follow the lifestyle recommendations.
I do the spinal twist as indicated.
Please elaborate further on each area below. Please include any questions or concerns you have as well.
Date *
Date
Disclaimer
Nutritional balancing is a means to reduce stress and is not intended as diagnosis, treatment or prescription for any condition or disease. Kelly Storrs is not a medical doctor and works as an unlicensed nutritional consultant only. Nothing on this site is meant to discourage you from seeking medical advice.