What is the Systems Survey Form?
The origin of the Systems Survey can be traced back to nutritional pioneers Melvin Page, DDS, and Royal Lee, DDS, and has evolved over the decades. The survey comprises a set of questions focusing on symptoms associated with the organs and glands of the body. While individual symptoms hold significance, patterns in symptom responses can help the practitioner decide where to focus further evaluation.
Intended for use by practitioners, the survey assesses patients’ nutritional needs from a holistic “whole system” perspective. It highlights survey groups with higher symptom scores for the practitioner’s review, helping practitioners develop customized nutrition protocols and select supplements for individual needs. This approach ensures that patients receive precise support tailored to their unique health requirements.
Groups 1 & 2
Sympathetic & Parasympathetic
- Questions in these groups relate to the autonomic nervous system and the balance between the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) systems.
- The sympathetic side is often compared to the body’s gas pedal, speeding up body processes and responding to stress.
- The parasympathetic side is often compared to the body’s brakes, focusing on rest and repair.
- Related symptoms and nutritional support options are listed for both sides for the practitioner’s review.
Group 3
Sugar Handling
- Questions in this group relate to how the body handles dietary carbohydrates, which can affect both sympathetic and parasympathetic balance.
- Symptoms in this group range from headaches and energy swings to cravings and fatigue after meals.
Group 4
Cardiovascular
- Questions in this group relate to heart and circulatory function.
- Related symptoms and nutritional support options are listed for the practitioner’s review, alongside diet and lifestyle considerations.
Group 5
Biliary and Liver
- Questions in this group relate to liver and gallbladder function, including fat digestion.
- Related symptoms and nutritional support options are listed for the practitioner’s review, alongside dietary considerations.
Group 6
Digestive
- Questions in this group relate to digestion, including protein digestion.
- Symptoms include heartburn and bowel changes; nutritional support options, such as digestive enzymes, are listed for the practitioner’s review.
Group 7
Endocrine
- Divided into six parts (Hyperthyroid (7a), Hypothyroid (7b), Hyperpituitary (7c), Hypopituitary (7d), Hyperadrenal (7e), Hypoadrenal (7f)), with questions relating to thyroid, pituitary, and adrenal function.
- Related symptoms and nutritional support options are listed for each part for the practitioner’s review.
Group 8
Foundational Issues
- Questions in this group relate to B-vitamin–dependent functions such as nerve function and energy production.
- Whole-food dietary considerations and nutritional support options are listed for the practitioner’s review.
Group F
Female
- Questions in this group relate to female hormonal health from preadolescence through post-menopause.
- Nutritional support options, including herbal products, are listed for the practitioner’s review, alongside lifestyle considerations.
Group M
Male
- Questions in this group relate to male hormonal health, including energy, libido, and stress.
- Nutritional support options, including herbal products, are listed for the practitioner’s review, alongside dietary considerations.
5 Main Complaints
- One of the most valuable parts of the survey.
- Gives patients a place to explain, in their own words, why they are seeking help, beyond the symptom questions.
- Patients can describe physical or lifestyle challenges, such as work stress, family issues, or physical limitations, that matter to them.
- How to address these is guided entirely by the conversation between practitioner and patient.