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

Email:  STSP@AdvancedClinicalNutrition.com
Need Help?  Call (940) 761-4045
Fax (940) 761-4405



STSPTM  NUTRITIONAL RE-EVALUATIONS



 
 

CONGRATULATIONS - WE CANNOT WAIT TO SEE YOUR IMPROVEMENT ON YOUR NUTRITIONAL "RE-EVALUATION" REPORTS.

PLEASE START HERE

  • This webpage provides Step-By-Step Instructions, Questionnaires, Forms, Articles and other information required to process Health and Symptom History for your initial Nutritional Evaluation Report. 
  •  
  • Upon receipt of each completed document to be sent to us, you may expect your Nutritional Evaluation Report to be emailed to you within 5-7 business days, exclusing dates closed for holidays.  Closed dates are posted on our "Contact Us / Hot Line" webpage.  Note:  The six pages that comprise the two Informed Consents listed below must arrive by USPS mail before we can email your Nutritional Evaluation Report.

  • We will not be able to contact you for any missing information, therefore, to be sure that your Nutritional Evaluation Report will be accurate, when completing questionnaires and forms to return to us, please take your time to answer each question honestly, completing each blank or put N/A if not applicable, so we know you did not simply overlooking answering the question.

  • However, please do not hestitate to call us if you need help with any of the following steps.  We are here to serve you and truly want you to enjoy the process, as well as receive the best health improvement results possible through Dr. Smith's professionally designed "Self-Therapy Supplement Program (STSPTM).

 
 
 
ANNOUNCEMENT!
UPDATED INFORMED CONSENTS
DUE TO "NEW" CARD PAYMENT PROCESSING GUIDELINES!

LOOK IN THE FOOT NOTES (LOWER-RIGHT CORNER) OF YOUR CURRENT COPY OF BOTH INFORMED CONSENTS FOR THE REVISED (R) DATE.  IF THE DATE IS NOT "R073018," PLEASE PRINT, SIGN, INITIAL AND RESUBMIT THE BELOW UPDATED FORMS.  THANK YOU!

 
---
Step 1-A
INFORMED CONSENTS

Please print two copies of all pages of the two Informed Consents (as left and right).  Sign and complete the blanks on every page and then USPS mail all six pages with original signatures to us within 24 hours.

 
Document
Informed Consent Clinical Nutrition Program (3 Pages)
  Document
Informed Consent Business Policies (3 Pages)

INSTRUCTIONS AND OVERVIEW
FOR COMPLETING
QUESTIONNAIRES AND FORMS





SYMPTOM SURVEY FORM (SSF)
(The Science Behind the SSF)
and an
INSTRUCTIONS AND OVERVIEW OF
ALL QUESTIONNAIRES & FORMS
ON FIRST (4-A1) AND RE-EVALUATION (4-A2)
WEBPAGES

Read this article for information regarding the above, additional instructions and important information you need to know to help you succeed in designing your own therapeutic supplement program.  

Document
FORMS OVERVIEW - 23 Pages

QUESTIONNAIRES & FORMS
COMPLETE STEP 1 to 5 TO SEND TO A.C.N. AND KEEP A COPY FOR YOUR RECORDS!

 

Step 1-B - SYMPTOM SURVEY FORM (SSF)

Type answers directly onto this form, then print two copies.
Keep one for your records and email, USPS or fax the other one to us.

INPORTANT NOTE:
In the Notes (bottom of page 2) of this form, type the date
for your next Re-Evaluation.  Example:  Re-Evaluation:   Month, Day, Year.

For Help In Calculating Your Re-Evaluation Due Date
Go to the Chapter Titled, "Re-Evaluation Schedule"
in the document titled, "How To Design Supplement Program."
This document is Step 2 on the attachment to Webpage 4,
titled
"B-Supplement Instructions."

Click here to go directly to Webpage 4-B


Document
SSF (2 Pages)
 

Step 2 - PHYSICAL STATISTICS FORM

Print one copy, record the information that applied to you when completing your Initial Nutritional Evaluation, then update this form for each Re-Evaluation.  For each Re-Evaluation, send a copy of your ongoing, updated Physical Statistics Form to us.

Document
STATS FORM - 1 Page
 
Document
Drug List - 1 Page
---
Step 3
DRUG LIST AND SUPPLEMENT LIST
  • Print the Drug List to update changes to current drugs you take or to record information about any newly prescribed drug.  
  • Print the Supplement List regarding any supplements you take daily or weekly that are not dispensed through Dr. Smith.

Document
Supplement List - 1 Page
 

Step 4 - SUCCESS STORY FORM (SS)

Please complete this on each improved symptom, 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 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.

  • only your success story is shared with your first name, not your last name and contact information, unless you have approved this on your form where indicated.
Thank you for sharing.

Document
SS
 

Step 5 - SCHEDULE FOR RE-EVALUATIONS (Blank Form)

When you have filled in the dates for all the columns from your 1st to 15th Report on the Re-Evaluation Schedule you printed for your first Nutritional Evaluation, you are ready to print the Re-Evaluation Schedule to the right to continue calculating the dates your next Re-Evaluation Questionnaires are due.  When you add a new date onto this form, email, USPS or fax a copy to us for your chart and for verification that you have calculated the correct Due Date.

Document
Schedule for Re-Evaluations (Blank) - 1 Page
 
 

ONCE THE ABOVE QUESTIONNAIRES AND FORMS HAVE BEEN SENT TO ADVANCED CLINICAL NUTRITION
PLEASE READ ALL ATTACHED WEBPAGES
IF YOU HAVE NOT ALREADY READ THEM.

THANK YOU AND GOD BLESS!

 

DID YOUR CURRENT OR LAST REPORT HAVE A RED ALERT REGARDING YEAST AND TOXICITY QUESTIONNAIRES?  CONTINUE READING....

 
OPTIONAL
TOXICITY & YEAST QUESTIONNAIRES
  • IF YOUR REPORT PROIVDED A RED ALERT REGARDING COMPLETING ONE OR BOTH OF THESE QUESTIONNAIRES, WE HIGHLY RECOMMEND THAT YOU DO SO. 

  • Otherwise, you may omit these or complete them at your discretion.

  • Note:  Even if there is no alert, completing these questionnaires periodically to monitor your own progress is recommended, then you will know when to take the appropriation before it appears as an alert on an updated Nutritional Re-Evaluation Report. 


Document
Toxicity Questionnaire - 3 Pages
---
TOXICITY QUESTIONNAIRE
  • The Clinical SP PurificationTM Program is indicated for those (female and male) who have six (6) points or more in any individual section of this questionniare OR if your grand total is 40 points or more, because you have tests for a level of toxicity that is harmful for your health. 
  • Hence, the reason your report indicated to complete this questionnaire in red letters. 
  • Below is more information on correcting the abnormal scores on this questionnaire. 

  • YEAST QUESTIONNAIRE
  • Scroll down a bit more for the answer to What is Yeast Overgrowth? and its solutions.  Scoring System is below:
    • FEMALE:   Scores over 61 indicate indicate that you have yeast overgrowth.  See Scores below:
      • MILD:  61-119
      • MODERATE:  120 - 179  and
      • SEVERE:  180 or higher. 

    • MALE:    Scores over 39 indicate indicate that you have yeast overgrowth.  See Scores below:
      • MILD:  40 - 89
      • MODERATE:  90 - 139 and
      • SEVERE:  140 or higher.

Document
Yeast Questionnaire - 2 Pages
 

TOXICITY QUESTIONNAIRE - HOW TO DETOX YOUR BODY AND THEREBY CORRECT ABNORMAL SCORES

  • The SP Clinical 21-Day or 30-Day Purification system or program is the solution for over-all body detoxification and and overview of this program is included in the "One Degree of Change" Cookbook, along with all the supportive dietary information, such as what to eat and recipes.
  • Direct Sale Detoxification Program are generally focused on cleansing the liver and colon only.  Our Purification system detoxifies the Liver, Gall Bladder, Kidneys, Bladder, Lymphatics, Stomach, Small and Large Intestines.
  • Contact Dr. Smith for cost of supplements for this program.  Note:  Though the cookbook talks of a 21-Day Purification Program, Dr. Smith has proven that 30-day programs are three times more effective than a 21-Day program, as thus renamed this program the "Full Body Detoxification Program." However, you may choose which best suits your goals.
  • Be sure to complete another Toxicity Questionnaire after completing your first 21-Day or 30-Day Program, if your numbers are below the criteria in the first sentence above, you have accomplished your goal.  If not, repeat the Purification System at least once every three months until your score is below 40.  Then repeating this program once a year is sufficient to maintain low toxicity.  However, if your work environment exposes you to toxins, such as glass, metals, chemicals, fabrics, etc., then repeat the Purification System every six months.   Ideal times are early Spring and Fall.

Click here for more information on the SP Purification Program,

which has been modified and refined by Dr. Smith and thus renamed the

SP Full Body Detoxication Program.


 

STSPTM  NUTRITIONAL RE-EVALUATIONS




                      WHAT IS YEAST OVERGROWTH?
                                               and
                      How To Correct Abnormal Scores
                          on the Yeast Questionnaire!

Yeast overgrowth at its most severe it is called, "Candida."  Yeast overgrowth is a sign or symptom c
aused by a biochemical imbalance called, "Dysbiosis."  One common term for this is "Leaky Gut."   Dysbiosis is even more severe than just yeast overgrowth because it involves the overgrowth of all germs in the intestines, including the loss of the friendly bacteria or flora that a healhty bowel wall produces to prevent this imbalance.  

Dysbiosis is caused from the side effect of taking pharameutical drugs that damaged the bowel wall, i.e., the part of bowel wall that produces friendly bacteria (flora) to monitor and regulate the growth of viruses, bad bacteria, strep, yeast and other germs while in intestines before evacuation through bowel movements.  Thereby, preventing them from causing infections and cancers in the intestines, as well as preventing them from breaking (leaking) through the bowel walls and adversely infecting the rest of the body.

Dysbiosis is at the root cause for all auto-immune diseases, including cance
r. 


Dr. Smith's 6-week Dysbiosis Program will correct this by providing the specific herbs that contain the nutrients the bowel wall needs to repair itself and thus begin to grow its own friendly bacteria.


Today many people take Probiotics thinking that is the solution for Candida and Dysbiosis.  If you have received some benefit from the Probiotics you have taken, you probably already know that within a few months after you stop taking Probiotics, you are right back where you started. 

Why?  Because Probiotics do not repair the bowel wall.  When you repair the bowel wall with Dr. Smith's Dysbiosis Supplement Program, you correct the cause of yeast overgrowth and Dysbiosis by repairing the bowel wall so it can makes its own Probiotics (friendly bacteria) again. 

This is a one-time, approximately six-weeks program.  In other words, as long as you do not take an antiobiotic, NSAID or other drugs that damage the bowel wall again, you never have to repeat tihs program.  If you think you need one of these drugs or others than cause Dysbiosis, call Dr. Smith to order the specific Homeopathic Remedies that are healthier alternatives, work fast and do not damage the bowels.  We have therapeutic homeopathics that detox bacteria, viruses, strep, and other germs even more effectively than drugs.  In the event you are in an accident and are hospitalized where you have no choice but to receive antibiotics and other drugs, as soon as you are discharged, simply repeat the Dysbiosis Program again to restore Eubiosis balance.

Keep in mind that the flora begins to grow after you complete the six-week Dysbiosis Program, and your bowels may take 6 months to a year to grow sufficient flora to combat the over-growth and restore proper management of germs while in the intestines. 

However,
after you finish your six-week Dysbiosis Program, if you complete the Yeast Questionnaire once a month and your grand total score gets lower and lower from month-to-month, you know the flora is growing and growing.  The Dysbiosis Program Instructions will inform you on when you do not need to complete monthly questionnaires. 

If any month indicates a higher number than the month before, recheck your Questionnaire scores for a possible error; however, if they are correct, then call Dr. Smith so she can help you determine what is interfering with your progress.  Most of the time it is simply a mathematical error on the Questionnaire.  

Then for preventative health care, once a year, complete the Yeast questionnaire to assure that you have maintained the healthy state of Eubiosis and have not caused the Dysbiosis imbalance to occur again.  If you have an abnormal score again, then simply contact us to reorder the supplements by themselves since you will already have the written Dysbiosis Program Instructions. 

                                        Dysbiosis Program Fee - $180
  • Written Instructions & 6-Week Supply of Therapeutic Supplements
  • Shipping and Handling Fee not included.


Prices may change without notice; current prices will be charged.

 
FOOTNOTE

Secure Website Info - Disclaimer - Copyright

Last Website Update: 04/02/2024  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
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