community Bridges

Integrated Health Care

Consultation


Please fill out the form below and submit. Your personal recommendations will be emailed to you by Ibraham Ahmed N.D., R.N. P.Ac.,A.D.S. Naturopath and Board Certified Acupuncturist as soon as he receives your submitted form.

Name
Email
Sex Age
   

Please check any symptoms you have below and answer the related questions

1. Tired in the morning After lunch After dinner
How long have you experienced this condition?

2. Need a nap after work/school/shopping - Under 1 hour Over 1 hour
How long have you experienced this condition?

3. Need extra hours of sleep Sleep poorly
How long have you experienced this condition?

4. Need to urinate during night - Once More than once
How long have you experienced this condition?

5. Weak urinary flow Delayed start Dribbling
How long have you experienced this condition?

6. Frequent bowel movements after meals
How long have you experienced this condition?

7. Weakness or heaviness in extremities Back
How long have you experienced this condition?

8. Poor appetite Poor sense of taste Frequent colds
How long have you experienced this condition?

9. Dry mouth Frequent bitter taste in mouth
How long have you experienced this condition?

10. Tired vision Weak vocal chords Don't like to talk
How long have you experienced this condition?

11. Poor hair condition Losing hair
How long have you experienced this condition?

12. Poor concentration Poor memory Nervous
How long have you experienced this condition?

13. Moody Upset easily Worry too much
How long have you experienced this condition?

14. Slow reaction time Premature signs of aging Poor coordination
How long have you experienced this condition?

15. Premature/weak ejaculation (men)
How long have you experienced this condition?

16. Difficulty reaching orgasm (women) Can't reach an orgasm
How long have you experienced this condition?

17. If you'd like an herbal dietary supplement for your liver
How long have you experienced this condition?

18. If under any kind of tumor treatment and wish to use an herbal dietary supplement
How long have you experienced this condition?

19. If you'd like an herbal dietary supplement for high glucose
How long have you experienced this condition?

20. If you'd like an herbal dietary supplement for high cholesterol
How long have you experienced this condition?

21. If you'd like an herbal dietary supplement for rheumatoid arthritic pain
How long have you experienced this condition?

22. If you'd like an herbal dietary supplement for upset stomach H. pylori positive
How long have you experienced this condition?

23. If you'd like an herbal dietary supplement for blemises (pimples)
How long have you experienced this condition?

24. If you'd like an herbal dietary supplement for flu/cold
How long have you experienced this condition?

25. If you'd like an herbal dietary supplement for chronic itch
How long have you experienced this condition?

26. Any other symptom(s)?