God’s Natural Healing Way Ministries, Inc.

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For this month!

For a Full Evaluation--Questionnaire & Saliva Sample

Answer the Questionnaire as follows:

1. Supply all of your personal and presenting problem information.
2. Answer ALL questions, including those for female or male, whichever applies.
3. Your answers should be relevant to your symptoms at the present time except for the appropriate questions dealing with past history, or specific time periods;  Example:  past 3 months.
4. If you need to make a comment about a particular question, include the question number and write in comments section.
5. Include any other information or medical diagnoses that you feel would be pertinent to your symptoms in the comments.
6. Print and use the female/male body pictures to mark or shade in the problematic areas you are experiencing.  Be sure to describe these as you mark them.  Use a colored or blue pencil or pen.  You will find these body drawings under the appropriate section for male or female.

The Saliva Sample--Follow directions below completely.

7. Build up saliva in your mouth on the tongue.
8. You need to use Q-Tips with paper stems NOT plastic stems.  Wet each side with saliva.
9. Place both Q-Tips in a blank envelope that DOES NOT HAVE security ink inside.
10. Place this envelope in another envelope and seal it. (You should be the only one handling this.)
11. Write your name and date on envelope.

Place the saliva sample envelopes inside an envelope that is addressed to us along with:

12. A copy of the body drawing indicating your problem areas.
13. Your remittance for $150.00 made payable to Natural Healing (if you are sending a check which you will indicate on the “Personal Information Page”.