Advanced Applied Microscopy for Nutritional Evaluation and Correction

LIVE BLOOD MORPHOLOGIES WORKSHEET

Date of Sample: //
Client Name: __________________________________ Date of Birth
________/________/________
Address: ____________________________________ City _____________________ Zip
_________
Telephone # Work # E-
mail
Digestive Rating
Roleau Formation RBC`s appear as 'stacked coins...........
Erythrocyte Aggregation (Microthrombi) RBC`s clumping.................
Protein Linkage/Endobiontic copulation RBC`s links/chains.................
Circulatory
Thrombocyte Aggregation Platelets clumping..................
Spicules/Filit Symplasts Fibrin needle-like projections.............
Chylomicrons Small motile particles oI blood Iats............
Protoplast Embryonic structures containing gestating microbes...
Atheroschlerotic Plaque/Colloid Symplasts Opaque globules oI plaque Iormation.........
Crystalline Structures
Red Crystals Indicate metals, bowel toxicity, inIection, poisoning...
Cholesterol Plaque/Colloid Symplasts Bright white crystalline structures or smears......
Blue/green crystals Tuberculin indication, aspergillus niger related......
Faceted Crystals Neurological indication................
Immune System Indications
Increased Eosinophils More than 2-4 per total white cells.......
Hypersegmentation White cell with 5 lobes...........
Neotrophil Viability Amoebic movement oI white cells.......
Fungal Forms Gray, dust-like particles/bud Iorms.......
Rod Forms Rod shaped microbes.............
Mycoplasma/Cell Wall DeIicient Forms/ Round donut shaped microbes...........
Sporoid Symprotits .......................
Colloid Thecits Good immune response............
Dioekothecits Alarm immune response...........
ther Indications Rating
Degenerated WBC`s/lysed/hyperseg.... Diplococcal Iorms................

Ratio between healthy/degenerate..... L-Forms/Cell wall deIicient Iorms.........

WBC viability............ Macrosymprotis/Mesosomes with Iila.......
Irregular monocytes ........... Sporoids....................

Motile rods.............. Tubular Iorms/Ascits with syntact nuclei........

Fibrous thallus/protoplasts........ Blastospores.................

Protit veil.............. Spheroplasts/Colloid Symplasts (round)......

Filit phase predominance....... Mychits (bacterial balls).............
Chondrit phase predominance...... Thecits...................

Sporoid phase predominance....... Ascits/Motile Rods...............
Mycelian phase predominance..... Synascits...................

Ascit phase predominance........ Acanthocytes...................

Microthrombocyte predominance...... Anisocytes....................

Mychit desme............ Macrocytes...................

Endobiontic RBC parasitism....... Microcytes....................
grade oI attack........... Ovalocytes....................
valence oI attack........... Poikilocytes..................

target RBC`s.............. Schisocytes...................

Chondrit on Erys........... Free chondrits..................
Vacuoles in Erys........... Echinocytes..................

Endobiontic WBC parasitism......... Hemolysis..................
attack on nuclei oI Leukosu...... Systatogenic processes.............
attack on Leucocyte plasma...... Sclerotic parasitic Iorms..............
Dendroid break up oI Erys....... Sclerotic changes in Erys............

Dendroid vacuoles.......... Pteroharpens.................

Valence of the Endobiont Valuation of Endobiosis
Remarks

Ferm. Growth Bowel Toxicity
Lymphatic Stress
Heinz Protein
Cal. DeI.
Mag. DeI.


Suggestions for Products:

Suggested
Nutritional Guide ife
Plus call 1-8-572-844 ref.#
_____________

Colon Formula Take 2 times
per day. Morning and evening Put spoon
(dinner spoon) into Colon Formula, bring
spoon back up, leave what is on the spoon
and put into shaker with 6-8 oz. oI juice in
it. Shake (do not stir) and drink
immediately, Iollow with water. Note:
-loating or gas can -e expected for 6-10
days.

!roanthenols take 2 mg Ior
every 1 pound oI body weight. After 14
days, go to 1 mg. Ior every 1-pound oI
body weight. (TAKE !RANTHENS
30 MINS. BEFRE EATING, R 2-3
HRS. AFTER EATING)

Example: $omeone weighing 175 l-s. would
take 4 (100 mg) for 14 days, and then take 2
(100 mg) thereafter.
igestive Formula: 13 x daily
or 2-3 x daily Take every 4-5 hours while
awake, preIerably with meals.

%' Plus: Take 6 with
breakIast, or take 3 with breakIast and 3
with lunch.

Prostate Formula 1-3 x per day

nnasa call 1-877-22-272
ref# _____________
mino ICC Protein and
Glutathione enhancer, 1 or 2 scoops daily,
may be mixed with colon Iormula. Should
take 2 scoops Ior the Iirst month or two.
Then down to one a day.

Primary %oxin Shield excellent
vitamin, take 6 per day, may split morning
and aIternoon.

# efense antioxidants, take 3 a
day, away Irom protein

Clear & Restore helps maintain
healthy intestinal floral in capsule form.
Take 3 per day.

Digest & Restore helps aid in digestion use 1 per meal
if taking the Amino ICG or 2 per meal if alone

Cal/Mag 4 at -edtime should help you sleep

Vit-C + MSM 1 tsp a day prefera-ly in morning




%rivita call 1-888-432-4829 ref#
______________
Sublingual B12, B,& Folic acid 1 or 2 tablets daily
under the tongue

Vitamin C Crystals dissolve 1 teaspoon into water or
juice can be mixed with Amino and Colon Iormula

Balanced Woman 1 or 2 tablets, 3times a day

AM/!M Vita Daily 1-am pack in morning and 1-pm
pack in the evening




valuation Profile
Thank you Ior your interest in having an evaluation completed Ior you. The individual who is perIorming your
evaluation is a Consulting Analyst. ThereIore, they will not only be using inIormation regarding physical
conditions and nutrition, but they will also be considering the combined eIIects oI environmental and emotional
stressors. This evaluation process is intended to assist in the determination oI causative Iactors which may be
related to traumas while have been sustained Irom the combined eIIects oI chemicals, diet, radiations, and
emotions. In order to assist in the completion oI the evaluation process, please respond to the Iollowing
questions in Iull.
our complete given (legal) Name M F
Street address (permanent home address including city, state, :ip)
!hone Number Work Number
Date of birth: (month/day/year) // Current Weight
!ersonal Information
Smoker: Yes How many daily? How many years? Never
Quit How long since you smoked?
Drink Coffee: Yes How many cups daily? How many years?
Never
Quit How long since you quit?
Drink Tea: Yes How many daily? How many years?
Never
Quit
Soft Drinks: Yes How many daily? How many years?
Never
Quit
Water: Filtered
Tap
Distilled
Bottled Spring Filtered
Medical Information escri-e what diseases are predominant on -oth sides of your family
Father:
Mother:
Do you experience digestive difficulties?
How often do you have a bowel movement?
Daily How many? Weekly How many?
Do your stools Iloat? or sink?
Have you ever done a cleanse? Yes Bowel? How oIten?
Liver? How oIten?
Gall Bladder? How oIten?
Never
Bloating? Yes Never Occasionally
Have you any amalgam dental fillings? Yes How many? Removed? Never
Root Canals? Yes How many? Never
Antacids? Yes How regularly? Never
What drugs have you taken? (Include. prescription, over the counter, and recreational) the last two
years.
What vitamins/nutritional supplements are you taking now and how long have you been taking
them?

Have you ever been hospitalized surgery? (What kind? When?)
Do you live near any high-power lines, agricultural projects, factories, new construction?
Yes No Never
Do you exercise? Yes How oIten? Never
ist all information that you feel may be relevant:
FEMAES N
Estrogen replacement therapy? Yes Which? Never
Birth Control? Yes How long? Quit? How long? Never
Under State and Federal Laws persons receiving services considered to be oI an experimental research nature by
the FDA/AMA must be inIormed oI such. An inIormed consent agreement is recommended Ior the protection oI
all parties involved. Please read, sign and return the below agreement. The inIormation being sought is oI a
nutritional nature and is not Ior a medical diagnosis, treatment, disease prevention, or health assessment. I
understand that this Iacility additionally accepts specimens Ior research purposes only. I hereby certiIy that I am
not an employee, agent, or otherwise aIIiliated with the Federal Drug Administration or an aIIiliated agency. I
understand that Nutritional and LiIe Blood Microscopy evaluation is a screening Ior research purposes only and
that the researchers conducting these sessions are not medical doctors. I understand that I will perIorm my own
Iinger prick, and that my specimen and data may be utilized conIidentially Ior research and statistical gathering
purposes. I Iurther understand: According to the Federal Food, Drug, and Cosmetic Act, as amended, Section
201 (g) (1), the term 'Drug is deIined to mean: Articles intended Ior use in the diagnosis, cure, mitigation,
treatment, or prevention oI disease. In other words, to 'say that a vitamin, mineral, or other Iood supplement
will have any eIIect on disease symptoms thereIore, that particular nutrient then becomes a drug under the law
as written. ThereIore, any suggested nutrition is not intended as a primary therapy Ior any disease or symptom,
but is an added schedule oI Iood supplementation provided solely to upgrade and enhance the quality oI Iood
delivered through the diet.
!lease include a $100.00 donation. II applicable, aIter the evaluation is completed, you may be
reIerred to complementary/preventive health care practitioners, advanced biological medical clinics,
and/or may receive nutritional inIormation Irom reputable companies.
Signature Date