Foundation for Integrated Medicine Questionnaire
Mediators Questionnaire
Antecedents Questionnaire
Triggers Questionnaire
Effects Questionnaire
Reducing Questionnaire
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The last time I can remember feeling really well for more than just a few days was: 

During the six month period before the date I have just written down, I experienced: (check all that apply)

A period of great stress —  
    At home
    At work or school
    In an important relationship
A major loss
A major triumph
An emotional trauma
An emotional breakthrough
A financial setback
An addition to my family
A new relationship
An acute medical illness
    (for example, an infection)
An accident or injury
"Food poisoning" or an "intestinal flu"
A dental problem or major dental work
A new medication (for example, taking an antibiotic)
A change of diet
A crash or fad diet
A change in exercise or activity level
A change in sleeping habits

A change in location of my home,school or workplace

A change in my use of —

    Nutritional supplements
    My soap, shampoo, or detergent
Renovation or new construction at home, work, school
A leak or flood at home, work or school
Foreign travel
Wilderness activities

If any of these events closely preceded a noticeable change in your health status, it may be seen as a PRECIPITATING EVENT.

If the Precipitating Event is a change in diet, exercise, sleeping habits or use of medication or personal care products that you undertook by yourself, try returning to your previous habits to see if your symptoms improve. If the changes were prescribed by a health practitioner, call these problems to his or her attention or discuss them with another doctor. If crash dieting is your Precipitating Event, start a nutrient-dense diet and consult a nutritionist.

If the Precipitating Event is a change in job or home location, new construction or renovation, a leak or flood, ask yourself how these have affected air quality or environment and pay special attention when you complete Part 3, Section 4 of the Health-MATE questionnaire.

If the Precipitating Event is an acute illness, an episode of "food poisoning", the use of antibiotics, foreign travel, wilderness activities, or extensive dental work, it may signal the onset of a chronic infection. Examples presented in Power Healing include parasitic infection and yeast infection. Other curable chronic infections which often go unrecognized include Lyme Disease, chronic sinus infections, dental abscesses and sexually-transmitted diseases. Ask your doctor or dentist about these.

If the Precipitating Event is a major loss, triumph, stress, or trauma, an addition to your family or a new relationship, start by taking stock of your emotional response and how this stress has affected your life and your thoughts. Pay special attention when completing Part 3, section 5 of the Health-MATE questionnaire. Short-term counseling or psychotherapy can help you unravel complex feelings which may be contributing to illness.

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