770.649.0094
4343 Shallowford Rd, Ste 150,Marietta, GA 30062
VIRTUAL CONSULTATION
TEXT US
Home Page
About Us
Pricing
WellnesslVibrant Aging
Weight Loss
Semaglutide
IV Therapy
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Wrinkle Fillers- Contour and Rejuvenate
Hyperdilute Radiesse
Vampire Facial(tm) -Microneedling with PRP
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Book
770.649.0094
4343 Shallowford Rd, Ste 150,Marietta, GA 30062
VIRTUAL CONSULTATION
TEXT US
Home Page
About Us
Pricing
WellnesslVibrant Aging
Weight Loss
Semaglutide
IV Therapy
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Wrinkle Fillers- Contour and Rejuvenate
Hyperdilute Radiesse
Vampire Facial(tm) -Microneedling with PRP
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Book
Home Page
About Us
Pricing
WellnesslVibrant Aging
Weight Loss
Semaglutide
IV Therapy
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Wrinkle Fillers- Contour and Rejuvenate
Hyperdilute Radiesse
Vampire Facial(tm) -Microneedling with PRP
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Book
Detoxification Questionnaire
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Detoxification Questionnaire
General Information
Date
Name:
Phone
Email
Please check off if you have these symptoms
Gastrointestinal symptoms
Belching or gas
Heartburn or acid reflux
Bloating or abdominal discomfort after eating
Bad breath
Aggravated by certain foods
Diarrhea
Constipation
Nausea or vomiting
Fewer than 1 bowel movement a day
Stools light in color
Liver
Wine makes you sick
Easily intoxicated if drinking alcohol
Hangovers after drinking alcohol
Sweat has a strong odor
Feet have a strong odor
Sensitive to chemicals
Sensitive to tobacco smoke
Bothered by aspartame (Nutrasweet)
Chronic fatigue or Fibromyalgia
Feel wired or jittery if drinking coffee
Mental Emotional
Feel "foggy", thinking seems slow or fuzzy
Bizarre vivid or nightmarish dreams
Depressed
Worried, apprehensive, anxious
Depressed
Nervous or agitated
Mentally sluggish
Difficulty concentrating
Mood swings
Poor memory
Energy levels
Weakness
Easily fatigued, sleepy during the day
Apathetic and energetic
Tired, in spite of a good night of rest
Feel drained after exercising
Skin
Experience hives, cysts, boils, rashes
Cold sores, fever blisters
Dry flaky skin
Acne
Itchy skin/dermatitis
Dull colored skin, yellowish, pale or grayish
Pale complexion
Skin has a sour or unpleasant odor
Muscoloskeletal
Pain or swelling in joints
Muscles become easily fatigued
Muscle aches and pains
Joints are painful upon waking
Need to use OTC pain meds
Joint pain after eating certain foods
Takes long to recover after exercising
Eyes
Dark circles around the eys
Puffy eyelids
Bloodshot or reddened eyes
Whites of eyes are yellowed
Eyes are watery and/or itchy
Inflamed eyes
Blurred vision
Ears
Ear infections
Ear drainage or discharge
Itchy ears
Ringing in the ears
Nose
Stuffy nose
Airborne allergies
SInus congestion, "stuffy head", sinus infections
Post nasal drip
Weight
Crave bread or noodles
Crave certain foods
Retaining water
Excessive weight
Weight fluctuates