How Scoring Works

Simple Answers. 
Meaningful Insight.

Thank you for taking this first step. This assessment helps Heather understand the full picture of your health before your consult call, so your 15 minutes together can go straight to what matters most for you.

You’ll start with a few short written questions about your health history, what you’ve already tried and your goals. Then you’ll move through 8 areas of health, from digestion and sleep to hormones and stress, rating how often you notice each symptom:

Never · Rarely · Sometimes · Often · Severe or Constantly

There are no right or wrong answers. Just answer based on how you’ve been feeling lately. Once you submit, Heather will personally review your answers before your call.

Before you begin

Please keep this page open until you submit.
Your answers aren’t saved until you click Submit at the end. Refreshing, closing this tab or going back will erase your progress.
  • Set aside about 20 minutes in a quiet spot.
  • Use the same device from start to finish.
  • Have a list of any medications, supplements and past surgeries handy.
  • If you need to step away, just leave this tab open. You can pick up right where you left off.


1. What is the main reason you reached out for support?*
2. What have you tried to solve or “fix” the issue?*
3. Please describe any previous surgeries, medications, or allergies.*
4. What are your top wellness goals over the next 3-6 months?*

Section 1: Digestive & Gut Function

1. Bloating or abdominal distention after meals*
2. Gas or excessive belching.*
3. Constipation (fewer than 3 bowel movements per week)*
4. Diarrhea or loose stools*
5. Alternating constipation and diarrhea*
6. Heartburn or acid reflux*
7. Nausea or feeling overly full after eating*
8. Abdominal pain or cramping*
9. Food sensitivities or intolerance reactions*

Section 2: Liver & Detox Support

1. Sensitivity to alcohol (even small amounts)*
2. Nausea or headache after alcohol or fatty foods*
3. Dark Circles under the eyes*
4. Frequent exposure to medications or supplements*
5. Chemical sensitivity (cleaners, perfumes, fumes)*
6. Feeling toxic, sluggish, or heavy*
7. Right-sided rib or upper abdominal discomfort*
8. Poor tolerance to fried or greasy foods*
9. History of gallbladder issues or gallstones*
10. Persistent bitter or metallic taste in mouth*

Section 3: Environmental & Chemical Exposure

1. Frequent exposure to pesticides, herbicides, or solvents*
2. Living or working in a high-pollution environment*
3. Mold exposure or water-damaged buildings (home, school, work, etc)*
4. Use of non-organic personal care products*
5. Reactions to fragrances or scented products*
6. Heavy use of plastics or microwaving food in plastic*
7. Occupational exposure to chemicals or metals*
8. Dental amalgams (silver filings) – (Never for No; Severe for Yes)*
9. History of smoking or secondhand smoke exposure*
10. Symptoms worsen in certain environments or locations*

Section 4: Hormones & Metabolism

1. Unexplained weight gain or difficulty losing weight.*
2. Weight changes despite similar diet and activity*
3. Cold intolerance or always feeling cold *
4. Heat intolerance or excessive sweating*
5. Sugar cravings or blood sugar crashes*
6. Irregular menstrual cycles or PMS symptoms (If not applicable- “Never”)*
7. Low libido or changes in sexual function*
8. Hair thinning or hair loss*
9. Acne or changes in skin related to cycles or stress*
10. History of thyroid, adrenal, or metabolic issues*

Section 5: Nervous System & Stress

1. Feeling overwhelmed or unable to cope with stress*
2. Anxiety or excessive worrying*
3. Irritability or mood swings*
4. Depression or low motivation*
5. Difficulty relaxing or “shutting off” the mind*
6. Sensitivity to noise, light, or stimulation*
7. Muscle tension, jaw clenching, or headaches*
8. Feeling wired but tired*
9. Panic attacks or sudden feelings of dread*
10. Burnout or emotional exhaustion*

Section 6: Immune & Inflammatory Symptoms

1. Frequent colds or infections*
2. Slow recovery from illness*
3. Seasonal allergies or hay fever*
4. Food-related immune reactions*
5. Joint pain or stiffness*
6. Muscle aches or body pain*
7. Swollen Lymph nodes*
8. Autoimmune diagnosis or family history*
9. Chronic inflammation or pain conditions*
10. Frequent fevers or feeling feverish*

Section 7: Sleep & Energy

1. Difficulty falling asleep*
2. Waking during the night*
3. Early morning waking with difficulty returning to sleep*
4. Feeling unrefreshed after sleep*
5. Daytime fatigue or low stamina*
6. Afternoon energy crashes*
7. Reliance on caffeine for energy*
8. Restlessness or tossing and turning at night*
9. Night sweats or overheating during sleep*
10. Excessive sleepiness during the day*

Section 8: Skin, Lymph, & Elimination

1. Acne, rashes, or unexplained skin issues*
2. Eczema, psoriasis, or chronic skin conditions*
3. Excessive sweating or body odor*
4. Swelling or fluid retention*
5. Tender or swollen lymph nodes*
6. Easy bruising or poor wound healing*
7. Dark or puffy under-eye areas*
8. Strong or unusual urine odor/color*
9. Infrequent sweating even with exercise*
10. Feeling better after sweating or bowel movements*
Please scroll to review the Disclosure & Disclaimer before continuing.

Disclosure & Disclaimer

I understand that the services provided are educational and wellness-focused in nature. They are not intended to diagnose, treat, cure, or prevent any disease, nor are they a substitute for medical advice, diagnosis, or treatment from a licensed physician or other qualified healthcare professional.

I acknowledge and agree that: Any information, protocols, supplements, lifestyle changes, or recommendations discussed are for educational purposes only and should be reviewed with and approved by my licensed healthcare provider prior to implementation.

My participation in sessions and use of any recommendations is entirely voluntary and undertaken at my own discretion and risk. Individual results may vary, and no specific outcomes or results are guaranteed. I am solely responsible for my health decisions and for determining whether any information or recommendations are appropriate for me.

I will seek emergency or professional medical care when needed and will inform my healthcare provider of any changes I make to my health regimen. The provider is not liable for any adverse effects, outcomes, or consequences resulting from the use or misuse of the information provided.

I confirm that I have read, understood, and agree to this Disclosure & Disclaimer.

Book Your Consult Call Below

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Comprehensive Health Assessment Consult

20 minutes
On Zoom
Congratulations on taking the first step toward your new health journey.
Email: hello@withheathermartin.com if you need a time outside of what is offered

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