Skin Gut iconsjiva Mind Body Soul Your Jivome 1. I would describe my skin as usually Oily Both oily and dry Dry Neutral 2. I usually experience the following on my face and body (Select all that apply) Pimples Dry or flaky skin Blackheads or whiteheads Redness or inflammation I don't experience any of these 2.1 I usually break out with pimples 3 or less times a month More than 3 times a month 2.2 When I break out, I usually get 5 pimples or less More than 5 pimples 2.3 The pimples normally appear on my Face Body Both face and body 2.1 I usually get dry or flaky skin 3 or less times a month More than 3 times a month 2.2 I would consider my dry or flaky skin to be Mild Moderate or severe 2.1 I usually get blackheads or whiteheads 3 or less times a month More than 3 times a month 2.2 When I break out with blackheads or whiteheads, I usually get 5 blackheads or whiteheads or less More than 5 blackheads or whiteheads 2.1 My skin gets red or inflamed 3 or less times a month More than 3 times a month 2.2 I would consider my redness or inflamed skin to be Mild Moderate or severe 3. I am bothered by the following on my skin or body. (Select all that apply) Fine lines Wrinkles Dark spots Uneven skin tone Thin or crepey skin Cellulite None of the above My fine lines bother me: Slightly Moderately A lot My wrinkles bother me: Slightly Moderately A lot My dark spots bother me: Slightly Moderately A lot My uneven skin tone bothers me: Slightly Moderately A lot My thin or crepey skin bothers me: Slightly Moderately A lot My cellulite bothers me: Slightly Moderately A lot 4. Based on the color of the skin on my inner forearm, my skin closely resembles 5. I have the following issues with my scalp and hair (Select all that apply) Too frizzy Too dull Too oily or sweaty Too dry or flaky Too sensitive or inflamed Hair is too thin or thinning None of the above 6. I have the following issues with my nails (Select all that apply) Pits or ridges Brittle or peel Too thick Inflammation or puffiness around the nails I bite my nails None of the above 7. I usually struggle with the following digestion issues (Select all that apply) Constipation Loose stools or diarrhea Gas and bloating I typically have a normal digestion 8. I experience heartburn Never Rarely Sometimes Frequently Always 9. My stress level is usually Low Somewhat low Moderate Somewhat high High 10. My anxiety is usually Low Somewhat low Moderate Somewhat high High 11. My ability to concentration is usually Poor Somewhat poor Neutral Good Very good 12. I normally become frustrated or angry Never Rarely Sometimes Quickly Very Quickly Please let us know your email so that we can send you detailed information about your holistic and unique balances and imbalances: Are you a health care or health affiliated provider? Yes No What state do you practice in? --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces (AA) Armed Forces (AE) Armed Forces (AP) What type of provider are you? --Select Type-- Acupuncturist/TCM Practitioner Ayurvedic Practitioner Licensed Esthetician Chiropractor Dietitian/Nutritionist Doctor of Osteopathy Medical Doctor Naturopathic Doctor Nurse Practitioner Other Pharmacist Physician Assistant Registered Nurse Student What is your speciality? --Select Speciality-- Allergy/Immunology Anesthesiology Bariatric Medicine Cardiology Complementary/Alternative Medicine Critical Care Medicine Dental Dermatology Family Medicine/General Practice Gastroenterology Geriatric Medicine Hematology/Oncology Infectious Disease Inpatient Medicine/Hospitalist Internal Medicine Nephrology Neurology Nutrition Obstetrics/Gynecology Ophathalmology Orthopedics Pain Medicine Pathology Pediatrics Physical Medicine/Rehabilitation Plastic Surgery Psychiatry Public Health/Preventative Medicine Pulmonology Radiology Rheumatology Sports Medicine Surgery Urology Other 13. On a normal night I sleep for Less than 4 hours 4 to 6 hours 6 to 8 hours More than 8 hours 14. After a night of sleep I typically feel Poorly rested Somewhat poorly rested Moderately rested Somewhat well rested Well rested 15. I become mentally or physically tired Never Rarely Sometimes Quickly Very Quickly 16. My main fitness goals are (Select all that apply) Lose weight Build muscle Improve cardio Improve flexibility Stay active 17. I typically make important decisions with Mostly with my heart and intuition Somewhat with my heart and intuition Equal heart and intuition AND head and intellect Somewhat with my head and intellect Mostly with my head and intellect 18. Normally I bounce back from failures and setbacks Very Slowly Slowly Neither slowly nor quickly Quickly Very Quickly 19. The top 3 things that are most important to me in life are Education Fame Family Health Inner Peace Love Money Passion Purpose Self-Confidence 20. The areas where I would like to grow personally are (Select all that apply) Emotional health Mental health Physical health Relationships Spirituality and Spiritual Growth 21. My dietary and food preferences are (Select all that apply) Dairy Free Gluten Free Grain Free Keto Paleo Vegan Vegeterian No Special Preferences Previous Next × Login This email is already linked to an existing profile and please login to continue with the quiz to update your results. Email Address* Password* Sign In Forgot Password?