1) Have you ever taken herbs or herbal medicine?

___Yes ___No (if No, proceed to question 2)

Are you currently taking herbs or herbal medicine?
___Yes ___No
Which of the following have you taken them for:
___Acute illness ___Chronic illness
___To improve well-being ___Other (please specify)____________
How helpful did you find this treatment? Please circle a number:
Not at all helpful 1 2 3 4 5 6 7 Very helpful

2) Have you ever taken vitamin or mineral supplements?

___Yes ___No (if No, proceed to question 3)
Are you currently taking vitamin or mineral supplements?
___Yes ___No
Which of the following have you taken them for:
___Acute illness ___Chronic illness
___To improve well-being ___Other (please specify)____________
How helpful did you find this treatment? Please circle a number:
Not at all helpful 1 2 3 4 5 6 7 Very helpful

3) Have you ever taken homeopathic remedies?

___Yes ___No (if No, proceed to question 4)
Are you currently taking homeopathic remedies?
___Yes ___No
Which of the following have you taken them for:
___Acute illness ___Chronic illness
___To improve well-being ___Other (please specify)____________
How helpful did you find this treatment? Please circle a number:
Not at all helpful 1 2 3 4 5 6 7 Very helpful

4) Have you ever used acupuncture?

___Yes ___No
Are you currently using acupuncture?
___Yes ___No
Which of the following have you used it for:
___Acute illness ___Chronic illness
___To improve well-being ___Other (please specify)____________
How helpful did you find this treatment? Please circle a number:
Not at all helpful 1 2 3 4 5 6 7 Very helpful