TREATING THE ROOT CAUSE OF DISEASE
Include your age at the time and all operations, even moles, etc. removed and circumcision.
Pneumonia, mono, tuberculosis., cancer, heart attack, chronic bronchitis, colitis, mumps, measles, chicken pox, etc. If it was more than one year, please indicate the age range. For example: Age 26-30. Treated for cancer.
Artist, graphic designer, dentist, dental assistant, gas station worker, painter, industry, computer cleaning, etc. If it was more than one year, please indicate the age range. For example: Age 26-30. Worked as a car mechanic.
Pregnancies/ births/ abortions/ IUDs/ episiotomy / fibroids / cysts, etc.
Please list prescriptions, street drugs, and the amount of alcohol, and cigarettes you've used in the past and present. If it was more than one year, please indicate the age range. For example: Age 26-30. Smoked a pack of cigarettes a day.
Please indicate whether there have been root canals, implants (titanium or zirconium?), extractions, cavities filled, crowns, a bridge or any other dental intervention on each tooth. Please refer to this dental chart and note that the wisdom teeth are numbers 1, 16, 17 and 32. Please indicate what materials were used in any cavities listed. Also, include the age of first silver amalgam fillings, braces, retainers, or night guards, etc. If you have recent dental x-rays, please upload them below above the "submit" box.
Write your chief complaint(s) below and rate the approximate age of onset. Also indicate the severity: "0" corresponds to no symptoms, and "10" corresponds to the most severely-felt symptoms.
Please read and follow these instructions for requested lab work or if you have recent blood tests upload them below. Recent dental x-rays may be uploaded below as well. These documents can also be emailed.