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Registration:

Designs for Health and Xymogen require client registration before placing an order.
 
Our registration page below is mandatory as per certain manufacturers and must be filled out before we can process your first order.  Our main goal is to be sure that you get the proper product for your needs.  We are happy to stay in touch with you about your health and assist you with any product recommendations or questions that you may have. Please fill out your information below as completely as possible so we may serve you better.
 
We appreciate your interest in our Professional brand nutritional supplements.
Once your registration is received, our nutritionist will contact you.  This process usually takes less than 24 hours depending upon the time of day your registration is submitted.  For an immediate response call us at 570-421-0665.  Our general hours of operation are from 10 am - 9 PM EST.  We look forward to being of service to you!~  

The following * fields are required

Contact Information:

*First Name

*Last Name

*Email

*Phone

*What are your primary health concerns?

*What product(s) are you interested in ordering?

Have you ever taken any of the products that you are interested in?

Yes No
Do you know how to use such products?

Yes No

 

*Do you have any nutritional questions?

*Do you have any allergies? If yes, to what?

 

*Do you have any chronic health concerns, i.e. Thyroid problems or blood sugar problems, high blood pressure or
 prescription medicines that we should know about to help you choose the best product for your needs?

Yes No  (if yes, please explain below)

Are you under the care of a health care practitioner?

Yes No

 

Check here if you would like us to call you for a free 15-minute Phone Consult
Check here if you would like us to email you recommendations

 

The next few questions will definitely help us to provide you with best products and information for your personal situation.

 

Rate each of the following symptoms based upon your typical health profile for the past 30 days. Select your response to each symptom. At the bottom, please check if you would like a free 15-minute follow up call to discuss your results or if you would like us to email you any recommendations.

 

Scale:

Never or almost never have the symptom.
Occasionally have it; effect is not severe.
Occasionally have it; effect is severe.
Frequently have it; effect is not severe.
Frequently have it; effect is severe.

 

 
HEAD

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Headaches

Faintness

Dizziness

Insomnia

 
EYES

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Watery or itchy eyes

Swollen, reddened or sticky eyelids

Bags or dark circles under eyes

Blurred or tunnel vision (does not include near- or farsightedness

 
EARS

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Itchy ears

Earaches, ear infections

Drainage from ears

Ringing in ears, hearing loss

 
NOSE

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Stuffy nose

Sinus problems

Hay fever

Sneezing attacks

Excessive mucus formation

 
MOUTH/THROAT

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Chronic coughing

Gagging, frequent need to clear throat

Sore throat, hoarseness, loss of voice

Swollen or discolored tongue, gums, lips

Canker sores

 
SKIN

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Acne

Hives, rashes, dry skin

Hair loss

Flushing, hot flashes

Excessive sweating

 
HEART

Never/

Almost Never

Occasionally/

effect not severe

Occasionally/

effect

severe

Frequently/

effect not severe

Frequently/

effect severe

Irregular or skipped heartbeat

Rapid or pounding heartbeat

Chest Pain

 

Disclaimer:

By pressing submit below you acknowledge and understand that NHTI’s nutritionists are not medical doctors. The services performed by NHTI’s nutritionists are at all times restricted to consultation on the subject of nutritional matters intended for the maintenance of the best possible state of nutritional health and do not involve diagnosing, prognosticating or treatment of disease. You are here on this initial and any subsequent visit online, in person or phone consult, solely on your own behalf.  Any medical questions, general or specific, should be addressed to a qualified health professional. Any application of the recommendations set forth, or implied, in the following consult/website is at the viewers discretion and sole risk. Nutritional Healing Technologies, Inc./Tricia Cardone, CN disclaims any responsibility for any adverse effects resulting from the information contained herein.  You acknowledge that your physician is your primary health care provider, and is responsible for supervising all changes in diet, exercise and nutrient intake that you make. By clicking below you agree with all of NHTI's terms and policies.

I Agree

My first and last name as typed Signature

By Clicking the submit you are in agreement to the above statement and all terms of use on this website.