Stress Survey

Stress Survey with Alternative Healing Works, L.L.C. - Serving Clients in Northwest Indiana

Fill out the Stress Survey below and receive an initial consultation for no cost, usually priced at $245

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1. Check off any of the following symptoms you have experienced in the past 6 months

Headache or Tension
Low Back Pain
Upper Back Pain
Allergies
Fatigue Tiredness
Neck Pain
Knee Pain
Weight Trouble
Reoccuring Pain
Wrist or Hand Pain
Ankle or Foot Pain
Shoulder Tension
Digestive Problems
Elbow Pain
Ringing in Ears
Numbness in Arms
Sleep Problems
Shoulder Pain
Nervousness
Numbness in Legs
Irritability
Hip Pain
Dizziness
Menstrual Problems
Other

If Other Please fill in here

Which of the above bothers you the most?

How long have you been bothered by the condition?


Describe how it feels or affects you when it is at its worst

2. Does this cause you to be

Moody
Irritable
Interrupt Sleep
Restricted on Daily Activities

3. Does this affect your work

Decision Making
Poor Attitude
Decrease Productivity
Exhausted at End of Day
Unable to Work Long Hours

4. Does this affect your life

Lose Patience with Spouse or Children
Restricted Household Duties
Hinders Ability to Exercise or Participate in Sport
Interferes with Ability to Participate in Hobbies or Other Desired Activities

Desired Activities

If you checked any of the above items, your organs are probably not functioning as well as they could and your energy is probably not flowing as smoothly as it could be.  


Natural Medicine Can Help You!


Natural Medicine gently and naturally helps to remove the stress that creates these health problems.  Would you like to get rid of the problem?

Yes
No

If your answer is Yes, there are several alternatives available to you. Please check the item most appropriate for you

I would like to come to the office for an initial evaluation and consultation.
I would like to attend a wellness class for further information.
I would like the office to call me to discuss my health problem before making an appointment.

How did you find our website? Friend or Family, Facebook, Twitter, Google, Other Search Engine

Would you like to schedule an appointment?

Yes. Please call me to schedule an appointment.
No. Please provide me with additional information.

Stress affects Northwest Indiana residents in many ways. Is your job performance suffering? Do you rush to and from work with every day seemingly ending in utter exhaustion? If you wake up feeling like you need another nights sleep even if you currently blame it on chronic allergies consider this. Stress is proven to increase blood pressure, contributes to unrestful sleep, causes fatigue and many more serious health problems and can even lead to depression if not managed properly.


It could be the frustration of commuting to work, your work itself, family problems, the irritation from a tennis or softball injury that will not go away or the persistent irritation of lower back pain brought on from yard work.


If your problems are stress related the team at Alternative Healing Works in Merrillville will help to relieve your stress with comparatively noninvasive, drug free Natural Medicine treatment. Natural Medicine not only helps to relieve pain but has been found to improve immune function, reduce and often eliminate allergy symptoms and can even provide a boost to chronic fatigue or fibromyalgia sufferers.


Please do not submit any Protected Health Information (PHI).

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