Drug Depletion/Side Effect Protocol
Please fill out the form completely.
What condition/diagnosis do you have?
Please list the drug name(s), brand(s) and dosage(s) that you are currently taking.
How long have you been taking this drug?
Please list any supplements or herbs which are taking. List brand name(s) and dosage(s).
Please describe your stress level, and how it affects you.
On average, how many hours do you sleep each night?
How would you describe your personality?
How many hours of exercise do you get each week? What type of exercise?
How much water do you drink daily?
Do you drink black coffee, tea, cola? If so, how much of each?
How much alcohol do you drink? How often?
Please describe your typical two-day diet.
How often do you eat out?
What snack food do you enjoy?
Do you suffer with gas & bloating after a meal?
Do you have any food allergies/sensitivities? If so, which one(s)?
Are your stools typically:
Do you take any kind of laxative or stool softener, including herbal ones?
If so, how often?
Do you take digestive enzymes?
If you were to eat a bowl of corn, how long would it take for you to see the corn in your stool?
Please describe what you believe are side effects from the drugs you are taking. Please describe in detail (dry mouth, constipation, sciatica, skin eruptions, etc.).
Would you like us to send a copy of your suggested protocol (minus personal details, of course) for ease of ordering to a supplier (Archeus Supply) so that you can call them to order whatever you need?
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