ADVANCED CLINICAL NUTRITION - Dr. D. Smith (940) 761-4045 Welcome to our secure Client website! | Our Cell-Friendly Visitor website is: AdvancedClinicalNutrition.Com - Dr. Smith Has Over 90% National and International Client Health Success Record!

1-HOME

2-FREE CONSULT REQUEST

3-CONTACT & COMPANY INFO

A-ABOUT DR. SMITH

B-COMPANY INFORMATION

C-SECURE CARD PROCESSING

D-INSURANCE CLAIMS

4-FAQ & LINKS

A-YES! WE CAN HELP YOU!!

C-AUDIO INTRODUCTION

5-WHAT OUR CLIENTS SAY

6-FREE SERVICES & MORE!

7-NEWSLETTER / SUBSCRIBE

A-ABOUT FREE EVALUATIONS

B-NEWSLETTERS 2014 to Now

C-NEWSLETTERS Prior 2013

8-SEMINAR & EVENTS

A-EVENT SCHEDULE

B-CHRISTMAS MAGIC - NOV

C-SECRETS TO HEALING-JULY

D-ABOUT ON-SITE TESTING

E-BCA REPORT-HOW TO READ

F-PUBLIC SPEAKING WEBPAGE

G-LECTURE REQUEST FORM

9-ARTICLES BY DR. SMITH

A-LIBRARY OF ARTICLES

B-VILLAGER PUBLICATIONS

C-WF PARENT PUBLICATIONS

10-WHAT YOU MAY NOT KNOW!

A-BLOG, FACEBOOK,TWITTER

B-POWER POINT SLIDES

C-ELECTRO-MAGNETIC (EMF)

D-YOUTUBES-COMA, HAIR, WT

E-YOUTUBES-FAT FALLACY

F-MENTAL HEALTH

11-E-BOOKS BY DR. SMITH

12-CNO SERVICES

A-ONLINE/BY-MAIL SERVICES

B-NUTRITIONAL ANALYSIS

C-NUTRITIONAL CARE

D-SPECIAL SUPPORT PROGRAM

E-DIETARY ANALYSIS

F-THERAPEUTIC VITAMINS

G-PERSONAL EDUCATION(PEP)

H-FULLBODY DETOX OVERVIEW

13-WHY TEST?

A-TEST/EVALUATION DEFINED

B-POOR HEALTH COSTS!

C-NUTRITION SAVES & PAYS!

D-HESITATING TO ORDER?

14-LABORATORY TESTING

A-HAC SYMPTOMS REPORT

B-BLOOD CHEMISTRY-44TESTS

C-THYROID TESTS-BLD/HAIR

D-HAIR MINERAL TESTS

E-SALIVA HORMONE-ADRENALS

F-SALIVA HORMONE - FEMALE

G-SALIVA HORMONE - MALE

H-URINE - (BONE TESTING)

I-STOOL / DIGESTION TEST

J-BLOOD TEST THROUGH MD

15-SELF-THERAPY PROGRAM

A1-FIRST EVALUATION

A2-RE-EVALUATIONS

B-SUPPLEMENT INSTRUCTIONS

C-DIETARY EDU & COOKBOOK

D-ARTICLES

E-ACUTE SYMPTOMS

F-DOUBLE HELIX WATER

G-AIR & WATER PURIFIERS

16-19 SUBSCRIBER PAGES

17-NUTRITION EDUCATION

A-FEEL BETTER 3-6 WEEKS!

B-BODY BY DESIGN

C-YOU CAN HEAL YOURSELF!

D-NOT TOO LATE TO HEAL!

E-DISEASES R DEFICIENCIES

F-DIET IS NOT NUTRITION

G-NUTRITION CONFUSING?

H-TRUE WORK SITE WELLNESS

18-EVALUATION FORMS

A-DIETARY QUESTIONNAIRE

B-SUPPLEMENT QUESTIONAIRE

C-TOXICITY QUESTIONNAIRE

D-STRESS OPINIONNAIRE

19-EVALUATION ANSWERS

A-DIET EVALUATION

B-SUPPLEMENT EVALUATION

C-TOXICITY EVALUATION

D-STRESS EVALUATION

20-NEW CLIENTS MUST KNOW

21-34 CLIENT WEBPAGES

22-NEW CLIENT INSTRUCTION

A-INFORMED CONSENTS-CPA

B-QUESTIONNAIRES

C-CLIENT FORMS

D-PEP BINDER DOCUMENTS

E-CLIENT ORIENTATION

F-INSURANCE CODES

23-RETESTING INSTRUCTION

24-SPECIMEN INSTRUCTIONS

A-ABOUT HAIR SAMPLING

B-FASTING INSTRUCTIONS

C-URINALYSIS TEST STRIPS

D-BLOOD TESTS FROM M.D.

25-REPORT OF FINDINGS

A-ORGAN, GLAND, BODY-HAC

B-BLOOD TESTING

C-URINALYSIS, ROUTINE

D-BONE RESORPTION URINE

E-HAIR MINERAL/METAL TEST

F-NEUROHORMONE TEST

G-FEMALE HORMONE

H-ADRENAL SALIVA TEST

I-STOOL TESTING

J-COMP-EDUCATION

26-PROGRESS (PR-CC/PEP)

27-EDUCATION (PEP)

1-DRUG FREE AMERICA

2-CANCER PREVENTION

3-BLOOD HEALTH

4-pH BALANCING

5-SKIN CELL REGENERATION

6-WHERE AGING FAST BEGINS

7-LUNG CAPACITY

8-HYDRATION

9-ORGAN & GLAND HEALTH

10-SLEEP HYGIENE

11-MILK-TRUTH ABOUT

12-MINERAL - IODINE

13-MINERAL - ZINC

14-SPECIAL ORDERS INTRO

15-MENTAL HEALTH FEEL JOY

16-SPECIALIZED PROG INTRO

17-ELECTROMAGNETIC (EMF)

18-REFLEX HEALING

19-BIOENERGY/NERVE HEALTH

20-REFLEXOLOGY

21-KEYS TO LONGEVITY

22-HEALTH MAINTENANCE

28-FORM & QUESTIONNAIRES

29-POLICIES & PROCEDURES

30-EQUIPMENT-AIR-WATER

A-DOUBLE HELIX WATER-DHW

B-PURIFIERS - AIR / WATER

C-CHI MACHINE-ALIGN SPINE

D-SAUNA (FIR & PORTABLE)

E-POWER EYES

31-PEP ADVANCED PROGRAMS

A-HEALTH CHEST EDUCATION

B1-DIETARY PLANS

B2-DIETARY PRINCIPLES

C-LIFESTYLE COACHING

D-MIND & BODY CONNECTION

E-ANATOMY DIAGRAMS

32-SPECIALIZED PROGRAMS

A-DIETETICS & WEIGHT MGT

B-DENTAL HEALTH PROGRAM

C-DYSBIOSIS PROGRAM

D-FULL BODY DETOX PROGRAM

E-SCAR DETOXIFICATION

F-SPORTS NUTRITION PROG

33-SPECIAL WEBSITE LINKS

A-HERBS (BULK & ORGANIC)

B-FOOD PRESERVATION BAGS

C-HOUSEHOLD PRODUCTS

D-LINENS-NATURAL FIBER

34-CLOSURE PROCEDURES

Want Results? Stop Taking The Wrong Vitamins! Best To Test Before You Buy!

 
     
TOXICITY QUESTIONAIRE

Is Your Health Adversely Affected By Daily Exposures to and
Ingestion of Toxic Substances from your Air, Food and Water,
e.g., chemicals, metals, fumes, fiberglass, to name a few?



 


INSTRUCTIONS
    
To Complete Your "FREE" Evaluation

  1. To show our appreciation and to say "Thank You" for subscribing, Dr. Smith offers your choice of one of four FREE EVALUATIONS.  Refer to right column for List of Free Evaluations and link to their web pages, as well as information on obtaining additional FREE EVALUATIONS. 
  2. To obtain the Toxicity Questionnaire (TQ), please complete the  "Evaluation Request Form." below.  This information is confidential and the questions asked either assist us with processing your Questionnaire for Evaluation or help us with demographic and marketing information.   Each question must be answered on the Request Form to receive your selected evaluation questionnaire. .
  3. Your personal contact information on this Request Form will only be used as it relates to processing your questionnaire and Evaluation, unless you, otherwise, indicate on this form.
  4. Upon receipt of your Evaluation Request Form, you will be emailed to you within 1-7 days with the User's Name and Password to access the web page titled, "EVALUATION - TOXICITY"  so you may print its questionnaire, obtain the assessment (or evaluation) of your answers and Dr. Smith's recommendations. 
  5. Important Note:  When you open the Evaluation web page, immediately click on the PDF Icon to print your questionnaire.  Then complete your questionnaire before reading the Evaluation web page.  Otherwise, the information on the Evaluation web page may influence your answers on the questionnaire.
  6. Why up to one week?  1) Sending your password is not an auto-reply, 2) this allows us to verify your subscription to our newsletter and/or your referred subscriber(s), which qualifies you for the Evaluation(s) of your choice, and 3) due to the volume of incoming Free Evaluations, this allows us time to assure that we are able to fulfill all requests.  Thank you for your patience. 
  7. How Do We Know Who Are Your Referred Subscribers?  On the Evaluation Request Form below, you will be asked to enter the name and email address for each of your referrals if you know who they are when you complete this request form.  If you do not know who or if you will refer anyone at this time, but later choose to do so, please ask the person you refer to put your name and email address on the Subscription Information Form, the space provided for "Who or What Referred You?" when they subscribe to our newsletter.
  8. Please be sure that you add our email address to your "accepted email" feature so that your Questionnaire and issues of your HealthQuest e-Newsletters will not go to Junk Mail. Thank you for subscribing.
  9. Should you have any questions about your Questionnaire, the Evaluation Results or any information on its Evaluation web page, please feel free to schedule an Inquiry Telephone Consultation with Dr. Smith, at no charge, by calling (940) 761-4045.
Links to information on each Free Evaluation is provided in the right column so you may read about each one to make your selection.  Thank you.

 
     
TOXICITY QUESTIONNAIRE
Request Form



EVALUATION REQUEST FORM - PLEASE CAPITALIZE ALL ANSWERS. THANK YOU. Date:
First, Middle Initial, Last Name:
Birthdate
Age
E-mail Address
Who or What Referred You to us? If internet search, please list keywords.
Cell Phone() -
Daytime Phone (Is this Home or Work#)() -
Evening Phone (Is this Home or Work#)() -
Best Days To Call (M-F)
Best Times of Day (C.S.T.)
Address Line 1
Address Line 2
City
State
Zip Code
Country
I am completing the DEO (Diet) Yes/No
Have you completed a DEO before? Yes or No
I am completing the NSQ (Nutrient Supplements - Symptoms Warrant Supplementation (Yes/No)
Have you completed a NSQ before? Yes or No
I am completing the Stress Opinionnaire (Yes/No)
Have you completed a Stress Opinionnaire before? Yes or No
I am completing the Toxicity Questionnaire (Yes/No)
Have you completed a Toxicity Questionnaire before? Yes or No
Do you want to schedule a Free Telephone Consultation with Dr. Smith to discuss the Evaluation Results? Yes, No, Maybe, Depends On The Results?
What prompted you to browse our website and what are you specifically wantinig help with or questions you want answered?
Are you interested in improving your overall health, starting with your most challenging health concerns, help with just your major health concerns, or a one-time nutritional support program to speed recovery of an acute illness or injury, or all of the above, as needed?
What is the approximate number of years you have been taking vitamins or other food supplements? Provide date or put "Never Taken."
Is there any other information Dr. Smith should know in assessing your Evaluation?
List of Names and Emails of People You Referred To Obtain Additional FREE Evaluations. Referrals are the highest compliment you can give us and we thank you, warmly.
 
 

Four Free Evaluations
To Choose From...


  • Dietary Evaluation Overview (DEO)
  • Nutrient Supplement Questionnaire (NSQ)
  • Stress Opinionnaire (SO)
  • Toxicity Questionnaire (TQ). 

After reading this webpage regarding the Toxicity Questionnaire/Evaluation, you may click on the above links to review information on the other 3 of the 4 FREE Evaluations to make a decision regarding which FREE Evaluation you would like to select as our "Thank You For Subscribing."  Then by referring three more friends to subscribe, you qualify for all Four Evaluations.  Complete the EVALUATION REQUEST FORM  to receive Passcodes to open web page for the Questionnaire and Evaluation you have selected.

 
 
 

FOOTNOTE

Secure Website Info - Disclaimer - Copyright

Last Website Update: 03/12/2025 8 a.m. CST

Disclaimer:  Information provided in website for nutritional ducational purposes only 
and not for diagnosis or treatment of any medical condition, disorder or disease
.
MAILING ADDRESS:  P. O. BOX 4652, WICHITA FALLS, TX 76308-0652
Copyright 2004  Dr. Donna F. Smith   All Rights Reserved
  .NET 8/22/18

You may have noticed Google is now placing a padlock icon to the left of some website addresses as an attempt to designate "secure" vs. "unsecure" website.  They are particularly interested in adding padlocks to website to assure the public that websites with shopping carts are secure for financial transactions, and not so much as a way to say the website is free of malware.  

Our website does not have a shopping cart because it is what is termed an "information only" website.  So our website has no need for a padlock.  Regardless of the reason, they are unable to add the padlock to our secure website because it is an older web design from the 1990's.  Therefore, no matter what warnings they may give you, rest assured that this website is secure.

Website powered by Network Solutions®