Supportive Therapies

Do you have any respiratory conditions?

Select any that apply.

Are you currently taking any of the following?

Select any that apply.

Do you have any implanted medical devices?

For example: pacemaker, prosthetic valve, or implanted port.

Please describe the medical device

Including the manufacturer and the date it was implanted.

Any additional conditions to note?

Select any that apply.

Have you received ozone therapy previously?

Are you currently taking any of the following medications?

Select any that apply.

Do you bruise or bleed easily?

Do you feel faint, dizzy, or anxious during blood draws or IV procedures?

Do you have any known allergies?

Select all that apply.

Do you have any of the following digestive conditions?

Select all that apply.

Have you experienced any of the following?

Select all that apply.

Have you had colon surgery?

Select all that apply.

Please describe the procedure.

Please describe the procedure. Subhead: Include the approximate date and type of surgery performed.

Have you had any of these diagnostic procedures?

How often do you typically have a bowel movement?

Select all that apply.

Your bowel health

Answer each question based on your experience over the past few weeks.

Your bowel health

Answer each question based on your experience over the past few weeks.

Your bowel health

Answer each question based on your experience over the past few weeks.

Your bowel health

Answer each question based on your experience over the past few weeks.

Have you taken antibiotics in the past six months?

Do you currently use digestive supplements or natural laxatives?

Which supplements or laxatives do you use, and how often?

Have you had colon hydrotherapy or enemas before?