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-INQUIRY QUESTIONNAIRE

3-CONTACT & COMPANY INFO

A-ABOUT DR. SMITH

B-COMPANY INFORMATION

C-SECURE CARD PROCESSING

4-FAQ & LINKS

A-YES! WE CAN HELP YOU!!

B-VIDEO INTRODUCTION

C-AUDIO INTRODUCTION

6-WHAT OUR CLIENTS SAY

7-FREE SERVICES & MORE!

8-NEWSLETTER / SUBSCRIBE

A-ABOUT FREE EVALUATIONS

B-NEWSLETTERS 2014 to Now

C-NEWSLETTERS Prior 2013

9-INSURANCE CLAIMS

10-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

11-ARTICLES BY DR. SMITH

A-LIBRARY OF ARTICLES

B-VILLAGER PUBLICATIONS

C-WF PARENT PUBLICATIONS

12-EDUCATION - FREE & FEE

A-BLOG, FACEBOOK,TWITTER

B-POWER POINT SLIDES

C-ELECTRO-MAGNETIC (EMF)

D-YOUTUBES-COMA, HAIR, WT

E-YOUTUBES-FAT FALLACY

F-MENTAL HEALTH

13-E-BOOKS BY DR. SMITH

A-ANTI-AGE-SKIN,HAIR,NAIL

B-FIBROMYALGIA E-BOOK

C-HAIR RESTORATION PROG

D-THANK YOU FOR ORDER

14-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

15-OUR 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

16-WHY TEST?

A-TEST/EVALUATION DEFINED

B-POOR HEALTH COSTS!

C-NUTRITION SAVES & PAYS!

D-HESITATING TO ORDER?

17-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

19-22 SUBSCRIBER PAGES

19-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

20-NUTRITION PROVIDERS

21-EVALUATION FORMS

A-DIETARY QUESTIONNAIRE

B-SUPPLEMENT QUESTIONAIRE

C-TOXICITY QUESTIONNAIRE

D-STRESS OPINIONNAIRE

22-EVALUATION ANSWERS

A-DIET EVALUATION

B-SUPPLEMENT EVALUATION

C-TOXICITY EVALUATION

D-STRESS EVALUATION

22-34 CLIENT WEBPAGES

23-NEW CLIENT INSTRUCTION

A - INFORMED CONSENTS-CPA

B - QUESTIONNAIRES

C - CLIENT ORIENTATION

D - INSURANCE CODES

24-RETESTING INSTRUCTIONS

25-SPECIMEN COLLECTION

A-SPECIMEN CHECKLIST

B-ABOUT HAIR SAMPLING

C-FASTING INSTRUCTIONS

D-BLOOD TESTS-LIST/DR LTR

E-URINALYSIS TEST STRIPS

26-REPORT OF FINDINGS

A-BLOOD TESTING

B-HAIR TESTING

C-URINALYSIS

C-NUTRITIONAL EVALUATIONS

D-SALIVA, URINE, STOOL

27-PEP BINDER DOCUMENTS

28-FORM & QUESTIONNAIRES

29-POLICIES & PROCEDURES

30-SPECIALIZED PROGRAMS

A-ANTI-AGING PROGRAM

B-DENTAL HEALTH PROGRAM

C-DYSBIOSIS PROGRAM

D-FULL BODY DETOX PROGRAM

E-SCAR DETOXIFICATION

F-SPORTS NUTRITION PROG

G-pH BALANCING

31-PEP LIFESTYLE PROGRAMS

A-HEALTH CHEST EDUCATION

B1-DIETARY PLANS

B2-DIETARY PRINCIPLES

C-LIFESTYLE COACHING

D-MIND & BODY CONNECTION

E-ANATOMY DIAGRAMS

32-EQUIPMENT-AIR-WATER

A-DOUBLE HELIX WATER-DHW

B-PURIFIERS - AIR / WATER

C-SAUNA (FIR & PORTABLE)

D-CHI MACHINE-ALIGN SPINE

E-POWER/KEY TO ANTI-AGING

F-POWER EYES

G-REFLEX MACHINE/TENS

H-HOT HOUSE (GERM DETOX)

I-SOQI BED / HOME SPA

33-SPECIAL WEBSITE LINKS

A-AUTO MAINTENANCE

B-CLOTHING-NATURAL FIBERS

C-FOOD-ORGANIC/FREE RANGE

D-FOOD - ORGANIC JUICES

E-FOOD PRESERVATION BAGS

F-FOOD SOURCE - VITAMIN D

G-FOOD SOURCE-EFAs (MILA)

H-HERBS (BULK & ORGANIC)

I-HOUSEHOLD PRODUCTS

J-LINENS-NATURAL FIBER

K-PERSONALCARE-TOOTHPASTE

L-PERSONALCARE - SUNBLOCK

M-SHOWER FILTER/BATHBALL

N-WATER BOTTLE W/ FILTER

34-CLOSURE PROCEDURES

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

 
 

FORMS AND QUESTIONNAIRES



 
 
 
 
A



ADRENAL FATIGUE QUICK CHECK (1 Page)

Document
ADRENAL FATIGUE
 


AXILLARY TEMPERATURE TEST (ATT) - ARTICLE & CHART

Basal Metabolism Testing for 
Hypothyroid Function Analysis 

You may print the entire article or only the last page.  The last page is the Axillary Temperature Chart.  Please read the entire article for temperature testing instructions and how to record your temperature on this chart.

Document
ATT ARTICLE & CHART
 
 
B


BLOOD PRESSURE & PULSE RECORD and CHART

  • Blood Pressure and Pulse Chart:
    • Provdes the normal readings according to your age.  These numbers represent the maximum numbers for healthy readings, which may differ from medical normal readings per age.
    • Find the numbers for Blood Pressure (Systolic and Diastolic) and Pulse for your current age and transfer this information where indicated on your printed copy of the "Blood Pressure and Pulse Record."  Remember to change these numbers when your age changes each decade.
  • Blood Pressure and Pulse Record:  This form is used to record blood pressure and pulse reading when you are currently receiving Clinical Nutrition Therapy to assist the body in normalizing blood pressure, when specially requested by Dr. Smith, and for preventative purposes.  Dr. Smith will verbally recommend or include on your Therapeutic Supplement Program of Care (POC) document how often to take your blood pressure and pulse.  Other instructions are included on this record form.

Document
BP/P Record
Document
BP/P Chart By Age
 
 
C

 
 CLIENT COMMUNICATOR (CC)

Print #1 CC and #2 CC below if you have 21 Symptoms or less, 
or all three, if you have over 21 symptoms that bother you the most.


#1 CC (21 or Less Symptoms)#2 CC (Side 2)#3 CC (22 or More Symptoms)
 

HAVE 43 OR MORE SYMPTOMS FOR 
THE CLIENT COMMUNICATOR, 
PRINT #1 TO #3 ABOVE 
AND #4 PDF TO THE RIGHT?


Document
#4 CC PDF
 

CLIENT INFORMATION FORM (6-Pages)
Update to provide new contact information for client,
physician, chiropractor and/or other professionals or
any other information on this form.


Document
CIF
 
 
D


DIET ACTIVITY REPORT

Document
DAR
 
Document
Drug List - 1 Page
---
DRUG AND SUPPLEMENT LISTS
  • Print the Drug List to the left to update changes to current drugs you take or to record information about any newly prescribed drug.  

  • Print the Supplement List to the right regarding any supplements you take daily or weekly that are not dispensed through Dr. Smith.

Document
Supplement List - 1 Page
 
 
H


HEALTH APPRAISAL COMPREHENSIVE (HAC) QUESTIONNAIRE
(6-Pages)


Document
HAC
 


HEALTH HISTORY FORM (4-Pages)



Document
HH FORM
 


HYPOTHYROID QUICK CHECK (1 Page)

Document
HYPO THYROID
 
 
 
I

 
INFORMED CONSENTS


 INFORMED CONSENT - CLINICAL NUTRITION PROGRAM 
(IC-CNP) - [1 Page]


INFORMED CONSENT - BUSINESS POLICIES
(IC-BP) - [3 Pages]

Document
IC - CNP
INSTRUCTIONS
  
Please read, then USPS mail both signed original Informed Consents to
Dr. Smith, if you have not sent this since its last update
 and
keep a copy for your records.  
Date of last update in bottom right corner of each page.

Document
IC - BP
 
 
M



MULTIPLE APPOINTMENT REMINDER (MAR) FORM

Document
1 Page - Print Front to Back
 
 
O



OSTEOPOROSIS FRACTURE RISK ASSESSMENT QUESTIONNAIRE (2 Pages)

Document
OSTEO RISK
 
 
P



pH URINE AND SALIVA -  7-DAY TEST FORM 

Document
pH 7-Day Form
 
 
S


SCAR/TRAUMA CHART (1-Page)
(Open, Type, Print)


Document
STC
 

SPECIMEN KIT INSTRUCTIONS AND CHECK LISTS

  
  • Open PDF Icon to the right for instructions to prepare for, collect and mail Lab Kits and/or have blood drawn and 
  • to complete Health History and Symptoms Questionnaires, then fax, email or U.S. mail questionnaires to A.C.N. 

Document
Print Checklist For Lab Testing
 
 
STRESS ASSESS QUESTIONNAIRE (1-Page)



Document
STRESS ASSESS
 

SUCCESS STORIES FORM

Please complete this on each symptom or health challenge, or the ones you are most inspired to report on, that has benefited from our clinical nutrition therapeutic services... so that:
  • we may have narrative feedback about your health improvement for our records.
  • we may share your success with others so they may be encouraged that Clinical Nutrition and Naturopathic Therapy Really Works!!!  Remember when you first became a client and was unsure about clinical nutrition therapy.  Your success story can be that deciding factor to give someone else the confidence to give clinical nutrition a chance to prove to them, too, that it works.
Thank you for sharing.

Document
SSF
 

SYMPTOM SURVEY FORM (SSF)
(2 Pages)

Document
SSF
 
 
U

 

URINALYSIS TEST STRIPS - RECORD (1-Pages)
Record monthly urine test results on this document and submit a copy of the updated record the day
before each Progress Reporting (PR) and Report of Finding (RF) Consultation Appointment. 

Document
UT RECORD
 
 
 
W

 
WEBPAGE PASSCODE LOG

  1. Print this log and keep it in a safe place.  As you receive services that include passcodes to open other web pages for educational information and forms, write them in the appropriate place on this log.
  2. These passcodes will be included on your invoice provided for payment of these services.  Otherwise, they may be communicated verbally at the consultation when education is presented or sent in an email.
  3. In case we have updated the website, but have not yet posted an updated Webpage Passcode Log, keep the following in mind.  Though the order of the webpages on our website may change and the webpage mumber that precedes the Title of the Webpage may change, the title of the webpages rarely change, so look for titles first. If you have any challenges with this call and ask that an updated log be emailed to you.

Document
Passcode Form
 
 
FOOTNOTE
Secure Website Info - Disclaimer - Copyright

Last Website Update: 04/16/2022
 
Disclaimer:  Information provided in website for nutritional educational 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  --  .NET 8/22/18
A Word from Dr. Smith regarding this Secure Website.  "I have had this website since the early 1990's.  As you can see by its design, it is from an original style where the left column is the navigation bar, instead of today's contemporary websites that have a drop-down Menu.  From the onset, this site has been secure from viruses and malware and still is. 

You may have noticed Google is now placing a padlock icon to the left of website addresses, which can be misleading if you do not know what it means.  If the padlock has a red slash across it, this means that the website is not secure for credit card processing.  A red slash does not mean the website is not secure from viruses and malware.  To be secure for card processing, the website requires an SSL (Secure Socket Layer) Certificate and special coding for this purpose. However, “Information only” websites, like this one, do not require an SSL because no currency is being processed through the website. Still, Google is placing the padlocks on all websites, and this is very misleading to those who do not understand their meaning.

Before the SSL Certificate and Coding, “https:/” represented websites that were SSL secure for card processing and “http:/” websites were not.  However, though an http:/ website is not secure for card processing that does not mean that it is not secure against viruses and malware.

Please be assured that websites with http:/, padlocks with red slashes, and pop-up warning signs are now an "automatic" response from Google crawlers when they come across a website that does not have an SSL (i.e., does not a padlock without red slash), even if the website does not require one (like information only websites) OR the website cannot be coded for an SSL Certificate because it is an original website design from the 1990's or earlier. This website is both…it does not require an SSL because it is an information only website and it cannot be coded for SSL because of its original design; hence it will always have the red slash over the padlock. .

This website contains over 1000 educational webpages, which our contemporary websites are not designed to accommodate any more. This is why I plan to maintain this original design website from Network Solutions, who guarantees all of its websites are all virus and malware free, whether of original or contemporary design, and currently I do not provide a website that processes card payments.

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