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Action Form: The Sexes Aren't Equal When It Comes To Booze

If you had a medical diagnosis, how difficult was it to get a correct one?
Don't Know Easy Difficult Impossible

What kind of experience have you had with the medical profession?
Don't Know Bad Good Excellent

If you used a alternative practitioner, what kind of experience did you have?
Don't Know Bad Good Excellent

What did you find worked for you?
Stress Reduction Vitamins Herbs Diet Change
Prescription Drugs Exercise Time-Off Body Work

Who would you like to be informed about this subject?
Medical Associations Government Regulatory Agencies Elected Representatives Drug and Supplement Manufacturing Companies


What following conditions do you think apply to you. (Check anything that might apply)

abuse of alcohol Anemia breast cancer
cirrhosis of the liver cravings for alcohol cravings
delirium tremens domestic violence drinking problem
drunk driving grief hangover
incest survivor inflammation of the pancreas mental deterioration
osteoporosis powerless Problem drinkers
sexual abuse sexually abused stomach ulcers
suicide ulcer


Check off any of the following items that you ingest.

amino acid calcium magnesium chicken
coffee fish folic acid
fruit glutamine magnesium
multivitamin niacinamide nicotine
refined food sugar vegetable
vitamin-C zinc


Check off any of the following therapies or procedures you use.

acupuncture affirmations alcohol free life
hypnotherapy massage meditation
reality therapy


Make your imput count. The information you submit will be compliled with all other submissions and used to activate for positive change in women's health.

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