The Conscious Body Breast Health Assessment

Do you now or have you had breast cysts? *

Yes

No

Do you have now or have you had swelling, pain or discomfort of the breasts? *

Yes

No

Have you had a suspicious mammogram or other breast test? *

Yes

No

Have you been diagnosed with breast cancer? *

Yes

No

Have you had a breast cyst biopsied or removed? *

Yes

No

Have you had any lymph nodes removed? *

Yes

No

Have you a history of constipation? *

Yes

No

Do you have irregular periods? *

Yes

No

With your period, do you have PMS or do you regularly get clots, excessive bleeding, swollen breasts or strong cramping? *

Yes

No

Do you have a history of eating disorders? *

Yes

No

Have you been exposed to X-rays, radiation, strong EMFs or lived near power lines? *

Yes

No

Do you have chronic neck or upper back pain? *

Yes

No

Are you diabetic, hypoglycemic or have Metabolic Syndrome X? *

Yes

No

Do you have a history of migraines or headaches? *

Yes

No

Do you have low blood pressure? *

Yes

No

Do you have a history of high cholesterol? *

Yes

No

Have you experienced a lengthy period of severe stress or grief? *

Yes

No

Have you had any injury to your chest or had a seatbelt bruise from a car accident? *

Yes

No

Have you used hormones of any kind, such as oral contraceptives, IUD, HRT, bio-identicals or topical hormone creams? *

Yes

No

Have you had any piercings or tattoos done to your chest?

Yes

No

Do you ever notice any bluish or greenish tinge to your underarm area? *

Yes

No

Do you wear an underwire bra? *

Yes

No

Do you wear a restrictive bra or athletic bra for more than 6 hours per day? *

Yes

No

Do you smoke or have you smoked for longer than 5 years? *

Yes

No

Have you ever worked with chemicals, plastics, paints or metals? *

Yes

No

So you have more than 3 fillings in your mouth or do you have any current dental infections or cavities? *

Yes

No

Have you never breastfed? *

Yes

No

Have you ever had mastitis or other breast infection? *

Yes

No

Are you over the age of 45? *

Yes

No

Have you had a positive genetic test for BRCA1 or BRCA2? *

Yes

No

Have you ever had bone spurs or stones? *

Yes

No

Do you have enlarged visible veins under the arms or anywhere on the chest? *

Yes

No

Do you take aspirin or other NSAID pain reliever daily? *

Yes

No

Do you get swelling of the ankles? *

Yes

No

Do you consume more than 1 alcoholic drink daily? *

Yes

No

Have you ever had fibroids, ovarian cysts or endometriosis?

Yes

No

Have you had a hysterectomy? *

Yes

No

Do you have low Vitamin D levels? *

Yes

No

Have you ever had staph or strep infections? *

Yes

No

Are you more than 25 pounds overweight? *

Yes

No

Do you exercise less than 3 days each week? *

Yes

No

Do you eat leafy green vegetables less than 5 times each week? *

Yes

No

Do you drink less than 8 glasses of water each day? *

Yes

No

Have you ever been diagnosed with low or hypothyroid? *

Yes

No