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Free Nutrition Report
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Professional Consultants

DONNA F. SMITH, C.C.N., C.N.
Licensed, Board Certified
Clinical Nutritionist

WILLIAM H. BRELAND, P.T., S.C.S.
Physical Therapist
Board Certified Sports Specialist

ROBERT J. WOLFF, D.C.
Chiropractor

T. ROGER HUMPHREY, M.D.
Physician

Advanced Clinical Nutrition
Wichita Falls, Tx
76309-3119
Office (940) 761-4045
Fax (940) 761-2881
E-Mail: wsnqas@aol.com


The information and services provided are for nutritional support, and not for the treatment of any medical condition or disease. By using this web site, you understand and abide by this disclaimer.

Copyright 1999
Donna F. Smith

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Questionnaires


     The Clinical and Sports Nutrition Analysis Questionnaires include all the questionnaires required for both initial and updated Clinical and Sports Nutrition Comprehensive Analysis. Monthly Progress Report Questionnaires include all the questionnaires required for Monthly Progress reporting. Regarding the other questionnaires listed, you will be notified when your clinical and sports nutrition program indicates the completion and sending of these specific clinical nutrition questionnaires, or if you desire, you may complete any questionnaire of interest to you and it to WSN for analysis for a minimal fee. The Success Stories Questionnaire affords you the opportunity to report your significant health and sports performance breakthroughs as they occur. Your Success Stories, then, keep us updated on your progress and become a source of encouragement to others!

Clinical and Sports Nutrition Analysis (CSNCA) Questionnaires

Monthly Progress Report (MPR) Questionnaires

Health Appraisal Comprehensive (HAC) Questionnaires
Dietary Analysis (DA) Questionnaires
Nutritional Blood Chemistry Analysis (NBCA) Questionnaires

Success Stories


Anthropometric

Axillary Temperature Test

Diet Activity Report

Dysbiosis Questionnaire
Elimination Assessment
Food Introduction Response
Metabolic Screening Questionnaire
Osteoporosis Screening Questionnaire
Primary Symptoms of Fibromyalgia
Sleep History Questionnaire