Psoriasis Healing Survey If you like complete my survey below. Your answers will be kept anonymous and safe. This will help me develop a natural healing protocol that works for you! This form is 100% secure, your information is safe. First Name * Last Name * Email Address * City * State / Province / Region * Country * Please select oneAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas (the)BahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean Territory (the)Brunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman Islands (the)Central African Republic (the)ChadChileChinaChristmas IslandCocos (Keeling) Islands (the)ColombiaComoros (the)Congo (the Democratic Republic of the)Congo (the)Cook Islands (the)Costa RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech Republic (the)DenmarkDjiboutiDominicaDominican Republic (the)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (the) [Malvinas]Faroe Islands (the)FijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern Territories (the)GabonGambia (the)GeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (the)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea (the Democratic People's Republic of)Korea (the Republic of)KuwaitKyrgyzstanLao People's Democratic Republic (the)LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (the former Yugoslav Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall Islands (the)MartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Midway IslandsMoldova (the Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands (the)New CaledoniaNew ZealandNicaraguaNiger (the)NigeriaNiueNorfolk IslandNorthern Mariana Islands (the)NorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippines (the)PitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian Federation (the)RwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSouthern RhodesiaSpainSri LankaSudan (the)SurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos Islands (the)TuvaluUgandaUkraineUnited Arab Emirates (the)United KingdomUnited StatesUnited States Minor Outlying Islands (the)Upper VoltaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Your age range? Please select one12 and under13-1819-2526-3435-4950-6970 or over How long have you had Psoriasis? * Please select oneless than 6 months6 months to 1 year1-3 years4-10 years11-20 years21-30 years30 or more years How severe is your Psoriasis? * Please select oneMild (20% covered or less)Moderate (50% covered or less)Severe (50% or more) Do you also have Psoriatic Arthritis? * YesNo Have you ever taken antibiotics? * YesNo What type(s) of Psoriasis do you have? Guttate Hinge Inverse Plaque Pustular Palmoplantar Palmoplantar pustulosis Erythrodermic I'm not sure Did Psoriasis start or flare after any of the following? Illness, trauma or injury Surgery Prescription drug usage Loss of loved one Major stressful episode Hormonal factors Have you ever had any of the following skin issues as well? Eczema Rosacea Acne Dermatitis Warts What Psoriasis treatments have you done or currently doing, if any? Topical steroid cream or oil Methotrexate UVB Therapy Biologic (Stelara, Enbrel, Humira, etc…) Have you had any dental work done? Root canal Crown Tooth Removal Silver Amalgam Fillings Other surgery Are you fatigued most days, feeling like you want to nap or can't make it through the day? YesNo Do you sleep at least 6-8 hours on average per night? YesNo Have you ever had a strep infection? * YesNo Have you ever had a viral infection like mono? * YesNo Have you ever had Shingles virus? * YesNo List all symptoms you have (soreness, fatigue, muscle pain, nerve pain etc) and any medications you have or are currently taking (antibiotics, steroids, statins, vaccines etc) Symptoms --> Do you have any of the following drinks often? Coffee Lattes Energy drinks Soda Flavored Water Additives Sweet/Unsweet Tea How much alcohol do you drink? * Please select oneNever1-2 drinks a year1-2 drinks every few months1-2 drinks a month1-2 drinks a week1-2 drinks every couple days1-2 drinks a dayMore Do you use tobacco products? * Please select oneNever1-2 a year1-2 a month1-2 a week1-2 every couple days1-2 a dayHourly How often do you eat fast food or at restaurants? * Please select oneNever1-2 times a month1-2 times a week1-2 times every couple daysOnce a dayMore How many liters of water do you drink each day? (32oz =1 liter) * Please select oneless than 1 liter2 liters3 liters4 or more liters What is your main water source? TapFiltered TapBottled If bottled, which brand? How often do you exercise? * Please select oneNeverOnce a monthOnce a week2-3 times a weekAlmost everyday How often do you eat fruits? * Please select oneNeverAt 1-2 meals per weekAt 1-2 meals every couple daysOnce per dayMore How often do you eat salads and raw veggies? * Please select oneNeverAt 1-2 meals per weekAt 1-2 meals every couple daysOnce per dayMore Do you take any herbals (teas, tinctures, supplements?) * YesNo Do you own a juicer? * YesNo Do you own a blender? * YesNo Do you have a family to cook for? * YesNo What is your monthly budget for natural healing? $0 - $50$51 - $100$100 - $200$201+ Are you already working on a natural path to heal your Psoriasis? * YesNo If yes, how long have you been working on a natural healing path? Please select oneless than 6 months6 months to 1 year1-3 years4-10 years11 or more years List any holistic treatments, therapies, herbal supplements, vitamins, teas, or other natural remedies if any. Lifestyle Questions (optional) Are you satisfied with your life and happy? YesSomewhatNo Are you in debt? YesNo If you are working now do you like your job? YesNo If you don't have a job, are you having trouble finding one? YesNo Do you get to spend enough time with family? YesNo As you heal, would you be interested in starting your own business from home helping others if it were simple and you had training? YesMaybeNo SUBMIT ANSWERS Thank you for taking the time to do this! You can heal. You WILL heal.