Health Scan - www.healthscan.co.uk - Gerard Kielty - Food Intolerance - Computerised Scanning

NETSCAN - ONLINE FOOD INTOLERANCE TEST

£90

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If you feel you would like to speak with Mr Kielty on the phone or Skype before proceeding please email in the first instance to arrange a suitably convenient time for both of you. email

Once we receive this completed health information form and PayPal payment we will post out your personal scanning kit of CD, probe and written instructions. We will email you to let you know that we have received payment and that your scanning kit is in the post. Take great care when completing your name and address details below to ensure that your information is full and clear and supported by a post code where applicable. Your scanning kit will be sent by registered post and we will send you tracking info once we have it.

Within 48 hours of receiving your personal electrical fingerprint Mr Kielty will test it against 108 foods. 9 Major "E" numbers. 30+ Herbs and Spices. Animal hair/skin. Dust/Feathers etc. He will then write a comprehensive report outlining the individual foods that suit your nervous system and those that don't. The written report will be in the region of 5-6,000 words. If there are any unusual foods that you eat on a regular basis and that you would like tested then please do let us know in the further information box below. If you are suffering from any respiratory or digestive system disorders this will also be addressed in Mr Kielty's report and advice given.

To continue please fill out the following form:

Your FREE! 243 page E-book (worth £10.00)
will be sent out at the same time as your online health advice

This is a secure webpage and can only be accessed by Mr GERARD KIELTY.
All correspondence is strictly private and confidential.
If you have any questions about this please contact Mr Gerard Kielty
in person by clicking here
This form should take no longer than 5 minutes to complete

Full Name:

Address:
Please write your postal
delivery address clearly
with post code if
applicable.

address

Skype Name:

Important!

Email Address:

Important!

Home Telephone:

Important!

Age Group:

Sex:

How did you hear about Health Scan:

Note: This information is totally confidential. It will only be read by Mr. Kielty. Under no circumstances will it be passed to any third party now or in the future.

A 'single' payment of £90 is all you pay - no matter how many boxes you check.

DO YOU SUFFER FROM?:
(Check box where applicable)

Nausea

Epilepsy

Asthma

Sleep Problems

Arthritis

M.E.

Migraine/Headaches

Diarrhoea

Nasal

Constipation

Post Nasal Drip

Bloated Stomach

Irritable Bowel Syndrome

Memory

Hayfever

Mood Swings

Thrush

B.P.

Mouth Ulcers

Eye Sensitivity

Eczema

Heartburn

Itchy Skin

Dermatitis

Irritability

Athletes Foot

Libido

Depression

Hyperactivity

Colitis

Crohns Disease

P.M.T.

Tinitus (Ringing in the ears)

Dizziness

Regular Ear Infections

Lethargy

M.S.

Weight

Concentration

Stress

Catarrh

Loss of confidence

Rhinitis

Coughing

High Blood Pressure

Hot Flushes

Low Blood Pressure

Haemorrhoids

Panic Attacks

Palpitations

Sciatica

Sinusitis

Sneezing

Tourette Syndrome

Colic

Explain here if you are "overweight" or "underweight" and by how much

Please tick the boxes that apply to you:
		Are you/have you taken at any time antibiotics more than once a year on average?
		Do you gag/almost vomit when brushing your teeth?
		Is your blood pressure about normal? If not please TICK BOX and give details in information box below
		Do you suffer from cramp?
		Do you suffer from gout?
		Do you take vitamins daily?
		Do you take minerals daily?
		Do you smoke?
		Do you sweat more than normal?
		Do you have a massage more than once a month? (If so please give details of oils used if possible in the info. box below)
		Do you have any medically diagnosed "allergies"? (If so please specify in information box below)

Further Information: Please provide any further information on your condition which you feel may be relevant.

Do you take on a daily basis: (Check box where applicable)
		Cod liver oil?
		Evening primrose oil?
		Garlic (as a remedy or in food)?
		Non prescribed remedies of any kind? (If so please give full details in further information box above)
		Do you use essential oils on a regular basis?
		Do you drink herbal teas on a regular basis?
		Are you a vegetarian?
		Do you have a sweet tooth?
		Do you cook regularly with herbs and spices?

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