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Exam Forms

*Forms/Lists Homepage

For the intuitive exam I have a big notebook filled with lists and information sheets. If you can muscle test asking your body what it needs you can use these lists. Of course I use qualifying questions when I work on you to tweak things and get things as perfect as we can for your body’s vibrational needs but these lists are a good place to start.

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*Products We Carry for Clients

Your body knows what it wants. It doesn’t care what the latest protocols are and it usually doesn’t like it when you load up on 20 different supplements for “prevention” of disease. It also doesn’t like to go out of its order—your own innate wisdom knows that order. Through muscle testing we explore what your body wants and give it the supplements, homeopathics and herbs that it wants TODAY. Following the body’s wisdom, in my opinion, is the best way to heal. I love these products and the homeopathics I carry because they are effective, high-quality (and reasonably priced). Let us help you design the game plan you need to get well. We love what we do. If we can’t help you before we take you on as a client we won’t let you be a client but will try to give you at least some help, a referral, techniques, or resources to get you going in the right direction.

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*What I Do, How I Work

The body is like an onion in that it has a healthy core. We build layers of dis-ease on top of that healthy core until sometimes we can have as many 8 layers of disease. These people are REALLY sick. Most of us don’t have that many layers. The body innately knows how it wants to be healed. The trick is to listen to the body’s wisdom. When the body wants something fixed in a specific way, sometimes it will not let the body know the deeper or less important causes until the major—most important ones—are attended to first.

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Client Intake Form

  Client:                                                                            Date: Patient:                                                                         Since: Address physical: Address mailing: City/State/Zip Phone (Home) Phone (Alt.) e-mail:...

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Consent Form Alternative

I understand and realize there may be risks and hazards in continuing my present condition without conventional medical treatment, but I am choosing to listen, understand and incorporate alternatives in eating habits, supplement programs or lifestyle changes that I feel will benefit my health and current condition. . . I also understand that it is not the intent of Dr. Denice Moffat to diagnose or prescribe. We are here to receive health information. In the event that I use this information without my doctor’s approval, I am prescribing for myself, which is my constitutional right.

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DMTEC Affirmation Form

Affirmation:  (I post mine in the bathroom) DOB: Rewrite on a 3"x5" card. Repeat out loud _____times/day x 30days. 1 2 3 4 5 6 7 Amen           And So It Is         Blessed Be           So Be It              Thank you God! Emotional Clearing Work: (One hour of this...

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Energetic Reading Page 1

Energetic Reading Page 1 is the first of two pages I use when tapping into your energetic field to see where your body is vibrationally out and where we need to start with your healing.

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Energetic Reading Page 2

Energetic Reading Page 2 is the second of two pages I use when tapping into your energetic field to see where your body is vibrationally out and where we need to start with your healing.

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Fingernail Analysis

I look for certain things when I read a set of fingernails. Let’s address them one at a time and I’ll tell you what I see most often and some possible causes (we call them “rule-outs” in the medical profession). In general, I look for abnormalities in the lunulae, color, texture and markings, shape, and pliability.

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List of Affirmations

When clients call and schedule a reading I ask your guides and angels if you need a personalized affirmation. If the answer is affirmative I build an affirmation for you, identify the order in which it should be said and test how many times/day you will need to say it to make a difference in your life.

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List of Alcoholic Beverages

Note that any flavoring in alcohol is suspect to problems. The FDA OK’s the flavorings because they are in small amounts (they call them GRAS which means Generally Regarded As Safe in the volumes used) but really the chemicals that cause the flavor most often cause cancer and multiple chemical sensitivities. Also, flavorings often have gluten in them. And drink mixers (like Margarita mix) often contain sulfites.

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List of Allergies

Homeopathic remedies do an excellent job at helping to manage all kinds of allergies, but you also have to do your part in avoiding the allergens that you can. My personal favorite line of homeopathics is Professional Health Formulations remedies. They are combination remedies that work quite well.

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List of Amino Acids

List of amino acids for muscle testing. For foods containing these specific amino acids go to Amino Acid Best Bet Foods handout.

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List of Antacids

An antacid is defined as a drug or dietary substance that buffers, neutralizes or absorbs hydrochloric acid in the stomach. Antacids may contain aluminum, calcium or magnesium. Note: It is dangerous to use Baking Soda as an antacid and alkalizing agent. One can easily overdose causing hypertension and possible stroke because it messes with your electrolytes. (Yes, even baking soda toothpastes can do this to some extent.)

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List of Anticaking Agents

Some foods containing anticaking agents include salt, nutritional supplements and medications, dried milk, egg mixes, sugar products and flours. Anticaking agents are also used in road salt, fertilizers, cosmetics and detergents.

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List of Antioxidants

Free radicals are thought to cause aging and diseases such as cancer. We produce many different free radicals within our body every day when we expose ourselves to microwaves, TV’s, computer screens, burned or charred foods, sunshine, toxic chemicals and cigarette smoke to name a few. Substances within our body called free radical scavengers are on alert all the time to identify and disable these harmful processes and the damage that they do to individual cells.

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List of Baby Formulas

Similac Advance Earlyshield Advance Organic Sensitive Sensitive R.S. Isomil Advance Isomil DF Alimentum NeaSure Go & Grow Enfamil LIPIL Gentlease LIPIL A.R. LIPIL Nutramigen LIPIL ProSobee LIPIL LactoFree LIPIL Pregestimil LIPIL Nutramigen AA LIPIL Nestle Good...

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List of Baby Products

When the baby can’t talk we need to figure out what products are safe and what can be used on and in the body. That’s where muscle testing comes in. We use this list to test the safest products for the infant—especially when they have any skin issues or allergies.

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List of Bagua Exercises, DVD’s and CD’s

Bagua involves the practice of walking circles, usually facing the body towards the center of the circle while holding your posture in specific stances. The goal to the exercises is to become flexible, learn body alignment and balance. As the moves become more complex body internal power mechanics are influenced. This is a list of many Bagua exercises, DVDs, CD’s and visual aids.

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List of Beans and Legumes

The difference between beans and legumes: Legumes are a class of vegetables that include lentils, peanuts, peas, and beans. It has to do with the way the seeds grow & split in order to germinate into plants. Both legumes and beans are plants that offer healthy complex carbohydrates. They are also good sources of protein, fiber, calcium, zinc, iron and folate, an important B vitamin. For vegetarians and those who do not eat red meat, legumes and beans are a nutritional must.

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List of Blood Pressure Medications

Diuretics act on the kidneys to get rid of salt and on the blood vessels to reduce resistance.
Beta-blockers lower blood pressure by slowing the heart and decreasing the force of cardiac contractions.
Vasodilators act on the arteries to widen them.
ACE inhibitors act as both vasodilators and diuretics by inhibiting the production of angiotensin, a powerful vasoconstictor hormone which also acts on the adrenal glands to keep more sodium in the body.

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List of Calciums

If you take the wrong form, the wrong dose or overdose and take it when you don’t need calcium it can build up at arteriosclerosis, bone spurs, or kidney/gallstones and possibly bladder stones. It’s complicated and the reason why I try not to address it.

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List of Cat Foods

When a cat comes in with allergies often vomiting or regurgitating their food because of corn or other allergies or they have little scabs on the body—particularly the face. These cases are often associated with what they are eating. I go through this list to muscle test which foods would not cause problems and which would be the best food for the body so that it can heal. I haven’t gotten a cat treat list yet. We’re working on all that stuff.

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List of Cleaning Agents and Laundry Detergents

Now there are some items on this list that consistently come up as highly allergenic and toxic for both humans and pets. Those items are Simple Green, Scrubbing bubbles, Bleach, Vinegar, Tilex, Plug-in Deodorizers, Oven Cleaner, Lysol and Pine-Sol. You may just want to switch to more earth friendly products if you have any chronic upper respiratory problems (like chronic coughing, skin rashes or asthma.)

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List of Condiments

It’s amazing the amount of condiments in this list. I had no idea–and I use quite a few of them. I guess I just didn’t consider them as condiments.

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List of Contact Allergies

Just a partial list for using when testing for contact allergens. Always start by asking the big questions. Then you can narrow it down after that. These are the big question categories that I can think of.

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List of Contraceptives

What’s the best birth control item for you? Are you allergic to any of the components? Which one is best balanced for your hormone system? Which ones won’t harm fertility in the long run? This is a list to use for muscle testing if there is a problem with your current contraceptive and for picking products that are better suited for your body.

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List of Cosmetics

Sometimes when clients consult with me for acne or allergy or skin challenges we have to work through a long list of possibly allergens they are applying to their face and their bodies. Many of these cosmetics are full of additives. Older (or shared) cosmetics can be full of bacteria. I use this list to figure out what items their body actually will tolerate and which brands are best. Gee, life used to be so simple when I was in High School! Look at this list! Immense.

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List of Crystals and Healing Stones

Wow, this is just a partial list of healing stones. The thing is, if you feel the need to touch or hold, a stone or you can’t take your eyes off of it or feel attracted to its energy in any way you should probably keep the stone in your possession until you no longer need it. Then it’s time to gift it forward to someone you think will care for the stone and honor it. Crystals were meant to share. We are their caretakers. After all, they’ll be here longer than we will be!

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List of Dog Foods

About once a year I spend a few hours updating this list. There are honestly about 4-5 new dog foods that come out every month it seems. I can’t keep up and it’s amazing. How to evaluate all these foods? I put the Rate Dog Foods link up which is helpful but I usually use muscle testing for the best diet. The challenge with that is that often people won’t be able to find the foods locally. Where does it end? I guess you just do the best you can.

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List of Dog Treats

There are a lot of dogs with allergies out there. It does’t help to spend big bucks on a special dog food if you don’t also make sure they are eating hypoallergenic dog treats. Does the FedEx delivery person or your bank give out dog bones? If so, what kind? Dogs with sensitive stomachs may not be able to handle this kind of food. Here is the list of dog treats I use to test with.

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List of Emulsifying Agents

What is an emulsifying agent? “Emulsifying agents are substances that are soluble in both fat and water and enable fat to be uniformly dispersed in water as an emulsion. Foods that consist of such emulsions include butter, margarine, salad dressings, mayonnaise and ice cream. Stabilizers maintain emulsions in a stable form. Emulsifying agents are also used in baking to aid the smooth incorporation of fat into the dough and to keep the crumb soft.”

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List of Energy Bars

So many people are into the quick-fix, quick-meal thing these days that they do ingest energy bars. Sometimes these things give you more simple carbs (and thus weight gain) than just grabbing a piece of fruit. So, what is the best bar for you? Let’s muscle test the list. . .

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List of Energy Drinks

Energy drinks seem to be quite popular but as a general rule most of my clients don’t tell me they drink these things that stress out the adrenal glands (they seem to be more into tea, coffee and chocolate for their vices) but occasionally someone will drink Red Bull, so I made a list of them for testing purposes.

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List of Essential Oils

List of Starwest Essential Oils I use for muscle testing, but I’ll also muscle test Young Living Oils for people who are distributors as well if they ask me to.

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List of Extracts:

Many extracts used in foods are made of chemicals and are not at all natural. Allergies build to these chemical extracts over time. This is a list I use for muscle testing allergies to extracts but the most common extract allergies I see is are to vanillin, maple, spearmint, strawberry and “natural” butter extracts.

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List of Fish and Seafood

Well I don’t know about you but we sure don’t have the variety of fish and seafood that is on this list! But hopefully we’ll be able to muscle test out a few things you can eat if you ever consult with me. Or you can check what fish and seafood is best for your blood type at www.dadamo.com

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List of Flower Essences

OK, what if you test strong for a flower essence but it’s not a Bach? Well, then you can muscle test if you should order from another company. Once you figure out which company you need to order from, go to their website and muscle test the essence to purchase. Here are some common companies from the book Encyclopedia of Flower Essences (which you should think about getting if you’re serious about muscle testing for a living.)

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List of Food Dyes

Some of these food dyes are not even legal in the United States (like Kipper Brown) but you know. . .I do think they somehow get back into the US through foreign made foods. I keep testing people are allergic to Kipper Brown but we can’t figure out what people are eating that still has that dye in it. I’ve read that chocolate flavoring contains up to 42 different chemicals! Yikes. I guess it’s best to go for the natural stuff.

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List of Fragrance Chemicals

I hear this all the time and the answer is no. People get all prettied up when they come to me. They wear all this foo foo stuff that I have to smell for days after they leave. It wasn’t good for my body. I guess over the years I’ve just exposed myself to too many bad chemicals and not I’m sensitive to them—but not as sensitive as the next person having an appointment at times. Many people these days are multiple chemical sensitive. They can’t even walk down the soap isles at the grocery store. And all the seminars I attend beg people not to wear any fragrances–people still do—I suspect they think no one will notice or they’re “above it all” or they just don’t think, but inevitably they have to ask people again and again. When you’re sensitive to the stuff it really makes you ill.

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List of General Purpose Food Additives

Food additives have been associated with cancer, autism, asthma, increased belly fat, ADD, ADHD, heart disease, headaches, aggression, lack of concentration, skin rash, high cholesterol, heart palpitations, birth defects, stomach pain, diarrhea, migraines and obesity.

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List of Grasses

Ahh spring. The season where everything starts to burst out of the ground a bloom. Allergies bloom at this time of year too for humans, dogs and horses if you can believe that. I’ve actually had to make some custom homeopathic remedies to help horses with their grass allergies over the years. Imagine being a horse allergic to what you eat most of the time. Crazy isn’t it? Anyway here’s the list I use to test with.

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List of Hair Products

One night I spent about 2 hours adding in the natural hair products available (forgot to add in links that night—duh!) then a few days later I decided to do a keyword search to see if I had missed any products. Well, none of the natural products were in the top 100 products! And yes, there were a LOT of brands that we all had missed. It’s taken several years to compile this list. It’s just easier for me to click on a website when I come up with a brand to muscle test out a couple of options for products just in case you can’t get one locally. Gee, this hair products page is longer than the dog food page! I for one have resigned myself to the fact that I’ll never look anything like the girls on these websites. How intimidating. I’m definitely not a “girly product” kind of girl.

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List of Herbal Teas/Coffee Substitutes

I’ve tried for years to get hooked on tea or a coffee substitute. I’ve tried nearly all of them I think. Still, there’s nothing as good as a nice cup of Millstone Bed and Breakfast coffee. But here’s the list I test people on if or when they want a tea or coffee substitute:

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List of Herbs (Scientific/Common names)

Scientific Name Name of Herb Medicago sativa Alfalfa leaf powder Medicago sativa Alfalfa Sprout seeds whole Aloes ferox Aloe powder Angelica archangelica Angelica Root powder Maranta arundinaceae Arrowroot powder Cynara scolymus Artichoke Leaf powder Withania...

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List of High Oxalate Foods

Oxalates are chemicals found in plant foods but not in most animal foods. Some people are more likely to form kidney stones if they eat foods high in oxalates. You may need to follow a low oxalate diet if you have gout, form kidney stones, do not absorb fat very well or have short bowel syndrome.

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List of Horse Supplements

It’s pretty amazing how horses are spoiled. Their owners give them quite the variety of supplements and treats. Sometimes though, horses have allergies to too some of the ingredients or too many of one supplement causes problems. It’s just easy for me to have a list of them to be able to tell the clients what will work for their pet after I’ve muscle tested the supplements they already give and tell them which ones are causing problems. Here’s the list of horse supplements. Treats are on a different list.

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List of Horse Treats

Lots of my clients are “clicker trainers” and need treats to train their horses. But, some horses are actually allergic to some foods. I use this list to see which foods the horses can be treated and trained with. Please note that this is only a list. I don’t carry or sell these items but have provided a resource link for the brands when possible. The list was updated 1/28/11.

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List of Juices and Beverages:

Fresh squeezed juice helps with detoxification because even though you squeeze out sour juice, as it goes through your body it comes out as alkaline ash. This is not what happens when you drink juice where it has been processes (canned, frozen, or pasteurized). These juices (especially fruit juices) make the body more acid. Also, those with any kind of sugar besides fructose make the body acid.

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List of Minerals

List of minerals I use in my practice for muscle testing. Ask if you have an excess of any mineral, then an overall mineral deficiency and if you get a no answer on both ask if you have any specific deficiencies then test from there.

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List of Most Toxic Cleaning Agents

This is a list of the cleaning agents that most often cause allergies. I’ve honed this list through experience and through muscle testing thousands of clients over the years. I hope it helps someone you love!

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List of Nutrients and Dietary Supplements

It’s difficult to find a supplement made of whole foods that has not been adulterated by some man-made ingredient. Take Vitamin C for example. To call it a vitamin C supplement it has to have a minimum of 100mg. of Vitamin C in it. But real foods don’t have that many mgs. of vitamin C. So, legally the company needs to add something the body would prefer not to have to be able to dispense a product that the body wants. It’s crazy. But here’s the list and sometimes people are actually allergic to some of these.

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List of Nuts and Seeds

Depending on your blood type you may do better with some seeds and nuts than others, but even if certain nut types are OK on your Highly Beneficial or Neutral list of accepted seeds and nuts you can be allergic to them. For example, I’m allergic to walnuts, pecans, and filberts or hazelnuts because they have a higher amount of picric acid in them. Sometimes a blood type B person will test they need pumpkin seeds or sesame seeds for a short time as their body is using specific components in these items as a medicine. But it’s never a long-term use. Here’s a list of seeds and nuts I use for muscle-testing purposes. . .

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List of Parasites A to Z

This is a list of parasites from A-Z that affect both humans and animals. I have this list broken down into specific categories under Diseases: Parasites as well. It’s a creepy world out there!

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List of Pathogenic Fungus, Molds, Mildews

In recent years we’ve had so much flooding that black molds which are very toxic are popping up all over the place. It’s big (but dangerous) business to remove them. Once you’ve been sensitized to one mold or fungus, the body is pretty good breeding ground for others. Candida (yeast) is considered a pathogenic mold. Many many clients with chronic diseases (including cancer) have yeast as a core cause of their health challenges. When you’ve got yeast you’re allergic to hundreds of other things. For some reason it sensitizes the body to more allergens. This is one reason why I like to work with my clients to prepare their bodies for a 5-Day Water Only fast. This gets rid of the yeast in a hurry and lots of the other allergies go away as well. But you do need to prepare for that experience. Not many clients follow through with my suggestion.

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List of Pet Shampoos

8-in-1 FerretSheen Deodorizing Shampoo  ActiPet Shampoo-Healthy Shine Adams Plus Flea & Tick Shampoo for Dogs, Puppies, Cats and Kittens Allerderm Allergroom Allergroom Conditioner Allergroom Shampoo Allergroom Shampoo Allermyl Shampoo Allermyl Shampoo Allermyl...

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List of Phobias

NeuroEmotionalTechnique (www.netmindbody.com) is usually very effective in treating phobias. Often a phobia will come up when I test out the core cause of dis-ease, but without a list like this, it is sometimes hard to track down what we need to clear. So, I’d like to thank Fredd Culberson for developing the list. He also has a cool poster for sale with all the phobias on it.

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List of Seasonings

Sometimes when I get a case where the clients has a headache all the time it’s because they are allergic to something they are eating every day. Often it is a component of a seasoning they routinely use and their diet is predictable with very little variety. I use this list to catch any offending agents.

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List of Spices and Culinary Herbs

Let’s see, the most common allergies among the list of spices are usually packets of spices (containing MSG), nutmeg and vanilla. Nutmeg has a phenol component. Pepper has strong lectins in it and can bind up in gut tissue in Blood Type O. Use spices in moderation or they will act as medicines unless you are using them as medicines like for chicken soup for your immunity (Parsley/Sage/Rosemary/Thyme) or for swelling (Parsley) or to calm the stomach and relieve flatulence (Fennel). Anyway, here’s the list. . .

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List of Spiritual Lessons

About 65% of the population it seems has the major life or spiritual lesson of Unconditional Love of the Self. With this lesson are lessons of self-esteem and worthiness intertwined with boundaries issues. All other lessons for these people are just distractions to what they are really here on earth to learn. I use this list to muscle test out the most important lessons for people to focus on in this incarnation.

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List of Splenda Containing Foods

Sucralose is used as a replacement for, or in combination with, other artificial or natural sweeteners like Nutrasweet and Acesufame. People that react to Splenda may also react to chlorine. For side effects possibly related to ingesting Splenda, see my Splenda handout.

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List of Stressors

Stress is a large part of the dis-ease process within the body. Some people have so much stress that they don’t know what to pay attention to in trying to manage it. I use this list to determine if stress is a major part of an illness, narrow it down to the types of stress involved, then give some suggestions on what techniques would best suit the clients body.

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List of Synthetic Flavorings and Adjuvants

It seems that many people are allergic to artificial vanilla flavoring, eugenols and natural butter flavoring. Here’s a list of man-made chemicals that are put into foods that people are allergic to. For me, the “natural butter flavoring” causes blood blisters to form under my tongue. It’s a real bummer.

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List of Treatment Modalities

Healing Techniques               Acupressure Emotional Melt Away Liver Gallbladder Flush Reflexology  Acupuncture Enemas Loving Yourself Exercise Reiki  Affirmations Energetic Repatterning Lymphatic Drainage Relaxation  Alexander Technique Energy Vortex  Clearing...

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List of Viruses

This is the list of viruses I use in my medical intuitive practice which includes both animal and human viruses many of which can be treated with specific homeopathics and a few which need to be treated by supporting the immune system.

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Pre-Exam Questionnaire

Although I don’t use this form when we do the consult often I’ll ask questions on this form. It’s a good memory jogger and many clients like to have a list of concerns for me to address or find core causes of. Every little piece of information helps. It’s all just bits and pieces of your life’s jigsaw puzzle. So here’s the jogger. . .

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Shoe Wear Analysis

Why do we wear our shoes out in certain areas of the foot? Usually it has to do with health problems and weaknesses in our bodies. Here is my foot wear evaluation handout.

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Symptom Survey Form

Patient name: ____________________________________ Date of Birth: ____________ Height: _______Weight: ______ This form is for the client. It will help you to remember what symptoms you have when you can't remember (that's called psychic amnesia by the way). Many...

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To Do List

As we consult about your health concerns I’m on the other end building you a list. Sometimes I’ll put down things you’ve taken as part of a maintenance program and other times I’ll write down drugs, special foods, homeopathics and supplements or glandulars that I want you to go purchase or that I’ll send as part of your transition into health. I have three columns that are empty for use when we update your body as we go along in the process so please have the form with you at the time of your recheck and review it often in between times.

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Tongue Diagnosis and Analysis

A normal tongue is pink in color, medium thickness, no cracks, ulcers, no teeth marks and with a light white moist coat (with root) on it. It has a look of aliveness and is supple (not stiff). There is no movement (quivering, trembling, side-to-side motion, curling or shifting to one side.) A healthy tongue looks like a piece of freshly killed meat.

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Vitamin List and Best Bet Foods

B Complex: Best Bet Food Sources– Any brand that you test energetically strong for. The wrong brand can be responsible for some annoying side effects. For me, that is urinary incontinence. To get the whole complex from foods you would want a wide variety of raw fruits, vegetables and whole grains.

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