Submitted by B

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Pre-Coaching Questions

   Your Name and Phone Number    ______________      Instructions:  Please answer the questions as best you can, you may just answer the multiple choice and/or add any text you wish. You may use a code in any essay question if you feel uneasy with writing your answers down for me. You may scan and email to  [email protected]  or fax to: 800­868­7298. Please give me a day to review your answers and then we can talk. You may  also fax any medical test results you wish me to review and discuss with you.

Describe your diet:

• 50% or more Animal
• 25% or more Animal       XX
• 10% or more Animal       XX        I would say somewhere between 25-10%, After I eat meat sometimes, I feel bad and go on a vegetarian diet for a while
• 5% or Less Animal
• 100% Plant

To Recover and increase expected life the science shows  ? 100% Plant is best

Describe your Bowel Movements:

• Every Third day
• Every Other Day
• Every Day             XX Usually daily or more
• Two Times per Day
• Three Times or More per day

Describe your Skin:

• Generally free of fungus and mold, even between toes, no yeast infection or thrush    XX

But very dry forehead at times even flaky

• Some fungus and mold, between toes or anywhere, yeast infection or thrush

List All Pharmaceuticals You Now Take or Have Taken in the Last Year ? ____________NONE_________  ? _________________________  ? _________________________  ? _________________________  ? _________________________  ? _________________________  ? _________________________  ? _________________________

Page 1 of 6

Pre-Coaching Questions

When Did You DIscover / Were Told You Had Cancer?

• ____about a year ago Hodgkins______________________________________________________

Comment: Add rebounding four or more sessions each day four or ive minutes of gentle rebounding will move the lympth assising in removing the toxins that are backing up.

What Standard Medical Treatments Have You Done and When

• Chemo                 None, dr said it was slow and should have a high cure rate, so I wanted to try alternatives
• Radiation
• Surgery

List all Alternative Programs You Have Tried – How Long and Your Experience

• ___Gerson   fruit and diet  for about a month or more didn’t seem to work
• ___Budwig and also combined it with gerson also didn’t seem to work much 1-2 months____________
• _1-2 G vitamin C______________________________________________

Comment: Cancer took years to get to the measurable stage

Plan on According to Dr. Kelley between six and eighteen months of enzymes at a therapeutic dosage to get rid of cancer.

You can stop progression within weeks in many cases with a  ? 100% Plant Diet

Please List All Accidents, Assaults, Surgeries or other trauma you have experienced

• _No Surgeries, or assaults ( I was attacked at school when I was younger by other kids) ____

Comment: Being attacked is an Assault –  instruction are contained in the Emotions document collection (free with purchase of enzymes)

• No trauma that I recall_____________________________________________________
• _________________________________________________________________

List Any and All Chemicals, Inoculations And Other (work related exposures)

•  __I work in a pharmacy, so I have been exposed to some chemicals_Dont know exactly which ones
• _TB inoculations____________________________________________
• _________________________________________________________________

Comment: You may want to test for heavy metals, but changing to 100% plant will reduce the heavy metal in any case

https://www.youtube.com/user/NutritionFactsOrg/search?query=heavy+metal

List Any And All Emotion FIlled Events You Have Experienced (For Example: Divorce, Death of Loved One, Employment Problems)

• _Death of father and mother probably affected me badly several years ago
• _________________________________________________________________
• _________________________________________________________________

Support From Spouse For Alternatives to Drugs, Surgery and Radiation

• Unconditional _________________
• Limited _____Limited____
• Struggling for Support _________________

Support From Family, Friends and Church

• Unconditional _________________
• Limited _________________
• Struggling for Support _________________

Probably none

Do You Consider Your Financial Condition As

• Fine _________________

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Pre-Coaching Questions

• Cautious _________________  somewhere between cautious and struggling
• Struggling _________________

Teeth

Any Amalgams _________________

Any Root Canals _________________

Any Implants _________________             None of these

Dentures _________________

Bridges _________________

Your Biggest Fears

• _getting ready for retirement on my own__
• _________________
• _________________

Your Biggest Regrets

• ___should have done things earlier__
• _________________
• _________________

Your Biggest Goals

• One Year _________________
• Three Years _________________
• Five Years _________________
• Beyond  ___retirement____

Home Condition

• Newer or Well Maintained _____x_____
• Older or Well Maintained _________________
• Older And Needs Work  _________________
• Other _________________

Weight loss is not unusual for a patient until they get on the Kelley Program Please note the following:

• Weight a year ago __225_
• Weight six months ago __215___
• Weight three months ago ________
• Weight two months ago ________
• Weight one months ago ________
• Current Weight_211__ Hight_5’7’’_ Age_49_

Page 3 of 6

Pre-Coaching Questions

Daily Activity Walking or achieving aerobic activity

Daily 5 Minutes ___if that_

Daily 10 Minutes __________

Daily 15 Minutes __________

Daily 20 Minutes __________

Daily 25 Minutes __________

Daily 30 Minutes or more  __________

Comment Recommended Walking – the more the better – add 5 minutes additional each day until you are walking at least an hour

You will gain more health and ability as you remove all animal products – your weight will normalize and you will have more strength.

Blood Type (If You Know) _________________ Detoxing

What Liquids Do You Consume Most Days (In Cups)

• Coffee __________
• Tea __________
• Milk __________
• Soda __________
• Bottled Juices __________
• Fresh Fruit Juice __________   I have been making more fresh juice sometimes.
• Fresh Veggie Juice __________
• Bottled Water __about 6 per day__
• DIstilled Water __________

Comment: Distilled is best instructions in dirty water book (Included wth purchase)

Juicing or Vitamixing veggie and Fruit will help you greatly

Coffee Enemas Most Days

• One Every Day  when I remember I do one a day but usually not unless I am on a protocol
• Two Every Day
• Three Every Day
• More

Comment; If you choose to follow the Kelley Progam you will need Enemas daily

Far Infrared Sauna

• Frequency ______

Any other Detox?

• ___vitamins and sauna sometimes___

Comment: Vitamins are not a detox. Sauna, Liver flush, mud soak, caster oil packs etc are.

Aches, Pains and Concerns

• Pain Frequency and duration

Sometimes strange pain in chest and chills at night wake me up

Comment: Likely pain will go away with the change of diet to plant.

https://www.youtube.com/user/NutritionFactsOrg/search?query=pain

• List other Concerns

Pre-Coaching Questions

• _________________
• _________________
• _________________

Sleeping

• Hours Nightly ____5-7 __
• Comments __ interrupted sleep ____
• Awaken _________________

Comment 8-9 hours if you can listen to the science:

https://www.youtube.com/user/NutritionFactsOrg/search?query=sleep

Which Of These Statements Best Describe Me

• I Do Best With A Written Plan         X
• I Do Best With General Guidelines     X  I can do with any of these
• I Do Best Researching and Figuring Out My Own Plan

Work Outside Home

• Full TIme _____Full time job  7 days on 7 days off____

Comment: You will have to adjust the amount of enzymes taken to accommodate your timing for enemas and work.

• Part Time _________________
• Not, But Want To _________________
• Retired _________________
• Unable To Work _________________
• Work At Home ?

Number of Children Under 5 _________________

• Number of Children Age 6 to 10  _________________
• Number of Children Age 11 to 18  _________________
• Ages of Disadvantaged Children You Care For _________________
• Disadvantaged or Elderly You Care For _________________

Help You Have Available (help for What?)

• Zero Hours of Help ______
• 1­3 Hours of Help _________________
• 4­6 Hours of Help _________________
• 7­9 Hours of Help _________________
• 10 or More Hours of Help _________________

Family History of Cancer

• Mother _________________
• Father ___colon cancer____
• Siblings _________________

Family History of Other Disease

• Mother __asthma_____
• Father _________________

Page 5 of 6

Pre-Coaching Questions

• Siblings _________________

Additional thoughts:

Read up on gut bacteria, considering your weight and sleep timing – my thought is your microbiome is in need of a 21-day detox and  probiotic re-inoculation  and a plant based diet.

https://www.youtube.com/user/NutritionFactsOrg/search?query=gut