A Brief Test & Daily Food Journal

 


6750 N. MacArthur Blvd.,
Suite 250
Irving, TX 75039
Ph: 1-972-253-4205
Fx: 1-972-401-0458

Modified Elimination Diet


Take this food sensitivity assessment below
and get results now!

(If you experience any of these symptoms below  for a week or more,
please contact Dr. Fine’s office to schedule an appointment .)

Digestive Tract
Diarrhea
Constipation
Bloated feeling
Belching
Passing gas
Stomach pains
Chest pain
Emotions
Mood swings
Anxiety, fear
Irritability, anger
Depression
Aggressiveness
Nervousness
Energy & Activity
Fatigue
Sluggishness
Apathy
Hyperactivity
Restlessness
Lethargy
Eyes
Watery eyes
Itchy eyes
Dry eyes
Swollen eyelids
Dark circles
Blurred vision
Weight
Binge eating
Cravings
Excessive weight
Compulsive eating
Water retention
Underweight
Joints & Muscles
Pain in joints
Arthritis
Stiffness
Limited movement
Aches in muscles
Feeling of weakness
Mouth & Throat
Chronic coughing
Gagging
Often clearing throat
Sore throat
Swollen tongue/lips
Canker sores
Nose
Stuffy nose
Sinus problems
Hay fever
Sneezing attacks
Excessive mucous
Head
Headaches
Insomnia
Skin
Hives, rashes
Hair loss
Flushing/hot flashes
Excessive sweating
Lungs
Chest congestion
Asthma, bronchitis
Shortness of breath
Difficulty breathing
Mind
Poor memory
Confusion
Poor concentration
Stuttering/stammering
Learning disability

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