EBOO Questionnaire - detoxforlife.biz

Welcome to Detox for Life, Thank you for your Interest in EBOO

Please fill out this brief questionnaire and someone will get back to you in 24-48 hours

Patient Questionnaire for EBOO

EBOO Questionnaire

Name

Email Address

Address

Phone Number

Best time to Call

Date of Birth

Height and Weight

Who Referred You

Do you take copper/iron, oral or IV

Have RA/AS, autoimmune, Lyme or cancer

Pregnancy

Thyrotoxicosis

Hemophilia

Low Platelet count

Atopic dermatitis

Uncontrolled hyperthyroidism (Graves Disease)

Active Seizures

History of heart attack

Do you have Low G6PD

Do you take photo active medication or are you photosensitive

Do you have a history of thick blood

Blood thinners

Blood Clots in Past 6 Months?

Myocarditis

Stroke in Past 6 Months?

Please list all Medications and Supplements

Have you had ozone before

If so any reaction

Are you allergic to heparin

Anticoagulants

Are you anemic?

Do you smoke (tobacco or cannabis)

Please list all allergies

Have you had these lab tests done in the past 6 months?

CBC

CMP

G6PD

If so, email results to detoxforlife1@gmail.com

Why are you receiving EBOO

Have you ever had a vasovagal reaction

What is your chief health concern, if any

Disclaimer: The information on this site is for educational purposes only. It is not intended as advice for self diagnosis or to replace medical care and are not a treatment or a cure for any illness or disease.