Nutritional Consultation with Nutripath, Stephen Heuer Informed Consent - Health Evaluation Form

 

Synergistic Nutrition - 864-895-6250 - support@synergisticnutrition.com - synergisticnutrition.com

In order to speak freely without censorship to our conversation and in order to utilize our right to freedom of speech, freedom of association and freedom to choose the type of health care you want to learn about and utilize, we must take our matters out of the public domain and bring them into the private by means of a private agreement format.

By signing this agreement, you acknowledge and agree to the following. Stephen Heuer is a Degreed Nutripath not recognized by any State or Federal Agency as a medical practitioner. Stephen is not a medical doctor and does not claim to be able to diagnose, treat or cure disease. He asserts that to every ailment there is a cause or combination of causes that need to be identified and removed. Once the cause(s) are removed and the body is properly nourished physically, mentally, and emotionally then the body's innate self-healing capacity takes over, so that healing can occur.

By signing this document, you agree to be a Member of The Private Health Care Association of Synergistic Nutrition. You understand that you have taken your health care needs out of the public domain and chosen to address them in the context of a private association. In a private agreement all disputes are solved between the private parties, and no governmental agency can be called upon to try to resolve the matter.

Additionally, I agree that the information being sought is of a nutritional and holistic nature and is not for medical diagnosis, or treatment of any disease. I understand that this facility accepts specimens for research purposes only. I hereby certify that I am not an employee, agent, or otherwise affiliated with the Food and Drug Administration, CLEA, or other regulatory agencies. I understand that any dietary guidelines I adhere to or nutritional supplements I take, I do so under my own free will choice and accept full responsibility for my actions.

 

I understand that detoxification is normal and to be welcomed as part of the journey of healing. I also understand that reactions to foods and supplements are something that can be remedied by talking to Stephen Heuer and that this is my responsibility to be sensitive to and adjust where needed. I understand some ailments are of a mental/emotional/spiritual nature and as such may go unaffected by nutritional intervention. As such they can only be addressed at the mental/ emotional/spiritual level.

 

Electro-Magnetic pollution is at an all-time high in modern society. Radiation from Smart meters, cell phones, cell towers, WiFi and now 5G technology are all harmful to life. Therefore, there will be recommendations to eliminate exposure to, or technologies recommended to protect you from these damaging EMF signals.

 

To prepare for your consultation, Stephen spends two or more hours studying the answers to your health evaluation form and creating your supplement schedule. Your zoom or over the phone consultation with Stephen will be 60 to 90 minutes long and is recorded. Because it is recorded you do not have to become distracted taking notes. For a standard comprehensive consultation, Stephen recommends that you do a 30-minute follow up consultation every four months for one year, to ensure that you are 100% on recovered or on well on the way to full recovery. For Chronic illnesses and cancer clients, your consultation fee is higher and accommodates 12 weeks of support Zoom or phone calls. These Zoom or Phone calls are also recorded and after 3 months of this support, you’ll be on your way to health recovery.

 

I have observed people to improve or heal from a broad spectrum of disorders, including cancer, cardiovascular disease, kidney failure, bone loss, joint pains, disc thickness restored, gum recession, digestive issues, constipation, mood, energy, blood sugar issues, liver health, hypothyroid, heavy metal toxicity, drug deposit toxicity, reproductive issues, menopause issues, warts and more. In short it does not matter the condition you find yourself in, nature has a set of laws that when followed automatically support the regeneration and restoration of full health to your body. I am here to teach you what those laws are, what has worked for others, what advanced supplements and technologies that can be used to support the recovery of health to your body.

 

If you are on an allopathic patented drug commonly called medication, then you need to understand that the medication is interfering with your body’s self- regulation and this in turn can block healing. There is almost always a superior natural means of supporting your health without the use of drugs. All patent drugs steal electrons from your body. Which means they subtract from your health and ability to heal.

 

Studies performed to show drug studies are manipulated in a variety of ways to show efficacy. One of those ways is to report relative risk rather than absolute risk. If one person out of two shows symptom improvement from taking a drug, then the drug company can say 50% of those studied showed improvement. When in truth only one person had symptom improvement and that improvement might have only been 1 to 3%. On top of that those studies are not reporting the increase in liver enzymes or the damage being caused to one's kidneys. Therefore, I recommend we discuss your natural options to drugs.

 

Peptides: Your body makes a myriad of peptides to regulate its functions. Production of these peptides declines with age. Therefore, if you are interested and open to this, I will be recommending injectable peptides as a component of what will support your body’s health restoration process. 

When you apply the diet and supplement recommendations and do all that is necessary, it is realistic to expect improvement in how you feel in the first 7 to 30 days, with even more improvement in the first 3 to 4 months. Most people who see me have issues that have taken years and decades to develop and therefore will take 1 to 4 years to recover optimal health.

 

Man-made fragrances are toxic to the body and environment. Therefore, you should replace them with essential oils. However, if you are coming for an in- person appointment, it is essential that you do not use any man-made fragrances from either perfume, colognes, shampoos, laundry soaps or dryer sheets.

Our relationship is a two-way street. I support you with the knowledge, instructions and expertise necessary to support your recovery of fantastic health. I save you potentially years of searching and tens of thousands of dollars in unnecessary expenses. I provide you the real answers. You support me by paying for consultation fees and buying the recommended products through my website. Buying the recommended products through my website is an essential component of maintaining a supportive relationship. When you do this, then I do not mind continuing to support you with answering your follow up questions by email or phone without charging you. That is unless you need more than 15 minutes of my time and expertise with each interaction. If you choose to buy the supplements from any other supplier then I require you to purchase 30 minutes of my time and expertise for every interaction with me.


All Sales and Consultation Fees are Final. There are no refunds of any kind or any reason.

I agree to use my typed name on the signature line in lieu of an actual signature as proof that I’ve agreed to the terms and conditions of this document

 

FIRST TIME EVALUATION

Please complete the following questions carefully.

This information will help me to build a specialized Nutritional Program personally designed for you.

12. Dental work: Indicate how many of the following you have:

In Traditional Chinese Medicine (TCM), health is viewed through the lens of balance between Qi (energy), Blood, Yin, Yang, and the organ systems. TCM practitioners historically use The Ten Questions (Shi Wen) to assess a patient's internal pattern of disharmony. The comprehensive symptom survey below is categorized by TCM diagnostic areas to help you identify patterns.

1. Temperature & Sweating (Chills & Fever)

2. Thirst, Fluid, & Taste

3. Digestion, Appetite, & Stomach

4. Elimination (Bowel & Bladder)

5. Sleep & Energy

6. Pain & Headaches

7. Skin, Hair, & Senses

8. Emotions & Mental State

9. Menstrual & Reproductive Health (For Females)

HEALTH OVERVIEW

4. Bowels: How is your bowel eliminations?

9. Electromagnetic Exposure: How many hours do you spend daily:

11. Personal Care Products: (Please take time to complete this list.)

FOOD CHOICES: Check each type of food that you eat often (once a week or more ):

FOOD STRESSERS: Please indicate how many times per week you consume the following foods:

FOOD HABITS

TYPICAL DIET: Please fill out your typical diet for the last few weeks. Please be as detailed as possible.(For example, instead of writing “chicken,” identify what brand and how it was made such as “baked Foster Farms chicken.” Instead of writing “salad,” identify what it’s made of, such as “salad made with organic baby green lettuce, commercial cherry tomatoes, etc.) PLEASE BE HONEST!

Bedroom/sleep considerations

Electrical Devices on Body

EMF Exposure

Toxic Body Exposure

DENTAL HISTORY CHART

EXAMPLE DENTAL HISTORY CHART

SCAR/TRAUMA CHART

PART I Read the following questions and check the number that applies:
KEY: 0= Do not consume or use 2= Consume or use weekly
1= Consume or use 2 to 3 times monthly 3= Consume or use daily
 

DIET

 

LIFESTYLE

 

Mediactions Indicate any medications you’re currently taking or have taken in the last month (0=no, 1=yes):

PART II
KEY: 0= No, symptom does not occur 2= Moderate symptom, occurs occasionally (weekly)
1= Yes, minor or mild symptom, rarely occurs (monthly) 3= Severe symptom, occurs frequently (daily)
 

SECTION 1 - UPPER GASTROINTESTINAL SYSTEM

 

SECTION 2 - LIVER AND GALLBLADDER

 

SECTION 3 - SMALL INTENSTINE

 

SECTION 4 - LARGE INTESTINE

 

SECTION 5 - MINERAL NEEDS

 

SECTION 6 - ESSENTIAL FATTY ACIDS

 

SECTION 7 - SUGAR HANDLING

 

SECTION 8 - VITAMIN NEED

 

SECTION 9 - ADRENAL

 

SECTION 10 - PITUITARY

 

SECTION 11 - THYROID

 

SECTION 12 - MEN ONLY

 

SECTION 13 - WOMEN ONLY

 

SECTION 14 - CARDIOVASCULAR

 

SECTION 15 - KIDNEY AND BLADDER

 

SECTION 16 - IMMUNE SYSTEM

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Synergistic Nutrition Google Reviews

Verified customer reviews for expert-curated supplements and nutritional guidance by Stephen Heuer

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  • "Stephen Heuer has extensive knowledge in helping you recover from any health challenge you are facing. I have had issues with my kidneys and Stephen has been invaluable in helping my health get better. You would do yourself a favor by getting a consultation from him for whatever health challenges you are facing."

    Mark Elliot — Google Review
  • "I've been enjoying the benefits of Synergy One and Green Meadow Whey for years now. At 71, they truly have made me feel 10 years younger — increased energy, better skin, rejuvenated hair growth, and increased libido being the primary benefits."

    Ernie Keller — Google Review
  • "I have used Synergy One for twenty years! I tried getting off it but noticed joint pain, so I got right back on. I will always use this product because it has raised my DHEA level and it seems to make my HRT work better."

    Sofia S. — Google Review
  • "I highly recommend Steven for all his products. I was sick for 5 days and my husband gave him a call — he gave some supplements plus the Green Meadow Whey protein and the following day I was getting better and my energy went back to normal in a few days."

    Salome Hine — Google Review
  • "After taking his recommended supplements, I've lost weight and improved gut health. The specific probiotics working in tandem with the recommended diet improved the health of my gut bacteria and made it extremely easy for me to keep from gaining the weight back."

    Jay Cooper — Google Review
  • "I had a hyperthyroid with shakes and fatigue — doctors wanted to put me on medicine for life. Steven put me on nutrition that completely healed my thyroid. The doctors could not believe the blood count and were shocked that another way of treatment was available."

    Glenn Poore — Google Review
  • "I have called on Stephen's expertise and knowledge in the field of nutrition many times over the years. He offers sound, practical advice and products that work. I highly recommend Synergistic Nutrition to my friends and family!"

    Mary Anne Wise — Google Review
  • "A wonderful experience. Stephen has so much skill and knowledge about health — he has taught me all I know about REAL health. I am forever grateful!"

    Jef Luke — Google Review
  • "Steve is extremely knowledgeable about supplements and how to use them. Very patient and caring. Knows his stuff, and more importantly — it works."

    Marko Zelenovic — Google Review
  • "Dedicated health practitioner. Trusted products. Stephen is ahead of his time. Great customer service."

    Kathleen Dillon — Google Review
  • "Stephen is always available and works on very tight deadlines. Knowledgeable nutritional advice you can trust."

    Glenn McBride — Google Review
  • "Knowledgeable nutritional advice you can trust. Great customer service and products. I highly recommend."

    Collette Ramirez — Google Review
  • "Synergistic Nutrition has some of the most potent supplements on the market today."

    Taiwan Brown — Google Review
  • "Very knowledgeable of the body and how to naturally repair it."

    Jackie SC — Google Review

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20 Minute Meeting

With Stephen Heuer · Eastern Time (USA)

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At the time and day of your appointment, please either join the Zoom meeting link sent to your email inbox or call 864-895-6250. All appointments are on East Coast Time, USA. If you fail to keep your appointment, the only way to have a new consultation with Stephen Heuer, is to book a paid consultation.

If Stephen already has paid consultations at the time of your appointment, you will not be called at your appointed time. You may book a 30 minute paid consultation instead.

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