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Natural Holistic Treatments for Chronic Disease

Dr. Hagmeyer Health Questionnaire

Ready to Reclaim Your Health & Experience A New Sense Of Energy and Purpose in Life? Discover Your Next Steps to Heal. Once completed, you will receive an email with personalized recommendations and some preliminary starting options. If you are a good fit for our services, we will send you an email with a link for a 15 minute phone consultation. During the phone consultation we can discuss the results of your questionnaire and determine the next best steps for you.

Step 1 of 3

33%

Name*
First
Email*
Part 1: Where Are You Beginning?
Have you been diagnosed with an autoimmune disease? (Graves, Hashimoto's, Type 1 Diabetes, Celiac, Crohn's, MS, Rheumatoid Arthritis, etc)
- Yes
- No
Are you following any specific dietary protocol? (AI, Paleo, AI Paleo, SCD, GAPS, Low FODMAP,etc)
- Yes
- No

Part Two: What Are Your Symptoms?
Skin
- Acne
- Skin rashes
- Eczema
- Hives
- Rosacea
- Skin or Nail Fungal Infections (athlete's foot, ring worm, toenail fungus, etc.)
Mind/Emotions-Mental Health
- Anxiety
- Depression
- Mood Swings
- Brain Fog
- Difficulty Concentrating
- ADD/ADHD
Hormone Imbalances
- Male Hormone Imbalances
- Irregular Periods
- PCOS
- PMS
- Infertility
- Uterine Fibroids
- Endometriosis
- Menopause
Digestive Tract
- Belching
- Bloating
- Constipation (less than 1-3 bowel movements a day)
- Diarrhea/Loose Stools
- Nausea or Vomiting
- Gas
- Foul smelling stool or gas
- Stomach Pain
- Intestinal Spasms
- Heart Burn and Acid Reflux
- IBS, Crohn's or Ulcerative Colitis Diagnosis
Joint/Muscle
- Arthritis
- Joint Pain
- Joint Swelling
- Fibromyalgia
Head/Nose/Lungs
- Asthma
- Congestion
- Dizziness
- Headaches
- Stuffy Nose
- Seasonal Allergies
Energy/Sleep
- Fatigue/Chronic Fatigue
- Low Energy
- Insomnia
- Sleep Disturbance
Other
- Low White Blood Count
- Autoimmune Disease
- Cancer
- Frequent Illness
- Thyroid Imbalance
- Weight Gain
- Vaginal Yeast Infections
- Itching (rectal, vaginal, ears)
- Carb or Sugar Cravings
- I Never Feel Full or Satisfied After I Eat
- Iron Deficiency
- B12 Deficiency
- I have Traveled Internationally
- I Have Had Traveler's Diarrhea
- I Have Had Food Poisoning and Never Felt the Same Since
- Histamine Intolerance

Part 3: Conclusion
I have a few other questions for you which will help me understand how to most effectively help you and determine the best place to start with you.
If you were to list your 3 main concerns, what would they be in order of most importance?
How would YOU describe the complexity of your condition?
- 1. Mild complexity (little to No impact on quality life)
- 2. Moderate complexity (affects most aspects of my life)
- 3. Severe complexity (I have been to numerous doctors and I am still suffering without answers as to why I feel the way I do)
What Do you feel you need the most help with?
- A) Just a bit of help- dietary changes and implementing those changes. Meal planning and recipes for SCD diet, Low FODMAP, Paleo, AI Paleo, etc
- B) I Need a Second Opinion- I’ve been to another Functional Medicine Doctor, have had some testing and I’m just not sure about everything. I feel something is just missing.
- C) Big Picture Approach- I need Dr Hagmeyer to thoroughly review my case. I need help with all aspects of treatment- Diet, Meal Planning, Recipes, Supplementation, Lifestyle, etc
- D) I'm in Bad shape- I don't know where to begin.
Do you have any thoughts about what could possibly be wrong with you?
My new patient paperwork will take you approximately 2 hours to complete, the details you provide to me will be critically important. You will be asked to complete a 3-5 page (typed up) health narrative-Your heath story.

I would then review all of this information including past laboratory tests, prior to your Report of Findings. During this report (60-90 minutes) I will explain how I want to tackle your case, the kinds of tests you need, and what I feel could be potentially causing or contributing to your problems.
Final Question- What is Your Health Budget. This can be the most important question when it comes to working with either myself or one of my clinical nutritionists or associates. Your financial ability will determine the kinds of testing, your treatment and how thorough of a workup I can perform. How would you describe your financial ability or budget for the testing you may require? *
- Less than $500
- $500-$1000 (Minimal Testing)
- $1000-$2000 (Moderate Testing)
- $2000-4,000 (Comprehensive Testing)
Insurance company does not cover treatment or testing.
After Dr. Hagmeyer reviews your questionnaire you will be contacted via email with your next steps.

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Suspect a Thyroid problem?

<img alt="Thyroid Popup 2" width="150" height="150" data-srcset="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png 150w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-80x80.png 80w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-100x100.png 100w" data-src="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png" data-sizes="(max-width: 150px) 100vw, 150px" class="aligncenter wp-image-27470 size-thumbnail lazyload" src="data:image/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw=="/><noscript><img onload="Wpfcll.r(this,true);" src="https://www.drhagmeyer.com/wp-content/plugins/wp-fastest-cache-premium/pro/images/blank.gif" class="aligncenter wp-image-27470 size-thumbnail" wpfc-data-original-src="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png" alt="Thyroid Popup 2" width="150" height="150" wpfc-data-original-srcset="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png 150w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-80x80.png 80w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-100x100.png 100w" sizes="(max-width: 150px) 100vw, 150px"/>

Complete our short health questionnaire right now to see if you are likely to be struggling with Thyroid disease

Lets Get Started

Do you suspect Candida Overgrowth?

<img alt="Thyroid Popup 2" width="150" height="150" data-srcset="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png 150w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-80x80.png 80w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-100x100.png 100w" data-src="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png" data-sizes="(max-width: 150px) 100vw, 150px" class="aligncenter wp-image-27470 size-thumbnail lazyload" src="data:image/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw=="/><noscript><img onload="Wpfcll.r(this,true);" src="https://www.drhagmeyer.com/wp-content/plugins/wp-fastest-cache-premium/pro/images/blank.gif" class="aligncenter wp-image-27470 size-thumbnail" wpfc-data-original-src="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png" alt="Thyroid Popup 2" width="150" height="150" wpfc-data-original-srcset="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png 150w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-80x80.png 80w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-100x100.png 100w" sizes="(max-width: 150px) 100vw, 150px"/>

Take the Quiz Right now and find out If you are likely suffering from Candida and how you score. Once completed you will receive several recommendations based on your score

Take Candida Quiz Now

Struggling with IBS, Bloating, Frequent gas, Skin problems?

<img alt="Thyroid Popup 2" width="150" height="150" data-srcset="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png 150w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-80x80.png 80w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-100x100.png 100w" data-src="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png" data-sizes="(max-width: 150px) 100vw, 150px" class="aligncenter wp-image-27470 size-thumbnail lazyload" src="data:image/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw=="/><noscript><img onload="Wpfcll.r(this,true);" src="https://www.drhagmeyer.com/wp-content/plugins/wp-fastest-cache-premium/pro/images/blank.gif" class="aligncenter wp-image-27470 size-thumbnail" wpfc-data-original-src="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png" alt="Thyroid Popup 2" width="150" height="150" wpfc-data-original-srcset="https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-150x150.png 150w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-80x80.png 80w, https://www.drhagmeyer.com/wp-content/uploads/2019/01/thyroid-popup-4-100x100.png 100w" sizes="(max-width: 150px) 100vw, 150px"/>

Find out if this sneaky gut infection and overgrowth of bacteria is really to blame for your IBS, bloating, fatigue, skin issues, or other unexplained symptoms!
Take the Quiz Right now and find out how you score compared to people who don’t have SIBO.
Once completed you will receive several recommendations based on your score.

Take SIBO Quiz Now

Struggling with Fatigue/Adrenal issues?

Take the Quiz Right now and find out how you score compared to people who don’t have Adrenal Fatigue. Once completed you will receive several recommendations based on your score
Lets Get Started