Stirred Water Herbs  

Helpful Information

Visit Our Store

307 S. Durham Hwy

Acra, NY 12405

Tel: 518-929-8228

Mon - Fri:    8am - 5pm

​​Saturday:      9am - 2pm

​Sunday:         Closed

Other Hrs:   By Appt.

(C) 2018-2019 Stirred Water Herbs

Questionnaire - Part II - Health History (continued)

Please select NOW if you're currently dealing with the condition, or PREVIOUSLY if you've experienced it in the past.
If neither apply, choose NEVER.

Digestion

Anorexia Nervosa ..... 

Belching ..... 

Bulimia ..... 

Bowel Habit Change ..... 

Crohn's Disease ..... 

Constipation ..... 

Diarrhea ..... 

Dysentery ..... 

Eating Disorders ..... 

Flatulence ..... 
Food Unappetizing ..... 

Gallstones ..... 

Heartburn ..... 

Hemorrhoids ..... 

Irritable Bowel Syndrome ..... 

Diverticulitis ..... 

Large Appetite ..... 

Liver Problems ..... 

Low Appetite ..... 

Nausea ..... 

Pain After Eating ..... 

Stomach Aches ..... 

Sudden Weight Change ..... 

Ulcer ..... 

Ulcerative Colitis ..... 

Vomiting ..... 

Indigestion ..... 

Parasites ..... 

Other ..... 

 

 

Allergies ..... 

Autoimmune Disorders ..... 

Catch Everything ..... 
Chronic Fatigue ..... 

Enlarged Spleen ..... 

Hashimoto's Thyroiditis ..... 

Heal Slowly ..... 

Immunodefocoency ..... 

Infections ..... 

Lowered Resistance ..... 

Lupus ..... 

Mononucleosis ..... 

Rheumatoid Arthritis ..... 

Sick Often ..... 

Sore Throats ..... 

Swollen Lymph Glands ..... 

White Blood Cell Count ..... 

Other ..... 

Immune System

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