Welcome to James Brent Health & Wellness

Medicine Men


Medicine men were the original health care practitioners. Now we have many types with many types of diplomas and licenses who practice health care (more often disease care) many ways. I believe there should be a return to the concept of medicine men. Medicine defined as an experience that supports health and promotes healing. This could be laughter, companionship, changes in sleep, diet and exercise habits, chemical supplements and surgical repair and of tissue that cannot be healed. The medicine used needs to be prescribed to treat person not the disease. Get to know yourself so your medicine can get to know you. Check out the health risk assessment and the health history and profile. 

Happiness and good health,

James Brent

Health Risk Assessment


On the answer sheet provided, please circle the number which best identifies your response to each corresponding statement.

1. Never or Almost Never

2. Occasionally

3. Often

4. Very Often

5. Always or Almost Always


Physical Activity

1. I engage in moderate physical activity outside of work for at least 20 to 30 minutes at least 5 days of the week.

1 2 3 4 5

2. My physical activity includes stretching, aerobic activity, and strength conditioning.

1 2 3 4 5

3. I use alternative modes of transportation whenever possible to and from various locations (i.e. stairs instead of elevator, biking or walking instead of driving).

1 2 3 4 5

4. I take the health benefits of physical activities and their lasting impact seriously.

1 2 3 4 5

5. I enjoy sedentary activities rather than physical activities.

1 2 3 4 5


6. I eat at least five servings of fruits and vegetables every day (one serving equals one half cup).

1 2 3 4 5

7. I eat at fast food restaurants less than three times per week.

1 2 3 4 5


8. I include foods that are high in fiber in my diet on a daily basis (i.e. whole grain breads and cereals, beans, etc.)

1 2 3 4 5

9. I maintain a healthy weight within the recommendations specified by a health care professional.

1 2 3 4 5

10. I avoid eating foods that are high in fat such as whole milk, fried foods, fatty meats, etc.

1 2 3 4 5

General Health

11. I avoid the use of tobacco products (cigarettes, smokeless tobacco, cigars, and pipes) and limit myself to 5 drinks of alcohol a week. (beer, liquor, wine)

1 2 3 4 5

12. I examine my breasts or testes on a monthly basis.

1 2 3 4 5

13. I protect my skin from sun damage by using sunscreen, wearing hats, and/or avoiding tanning booths and sunlamps.

1 2 3 4 5

14. I visit my dentist every six months for regular check ups.

1 2 3 4 5


15. I see my physician for routine check-ups, health screenings, and disease prevention.


25. I regularly take interest in and interact with others.





1 2 3 4 5


1 2 3 4 5

Emotional Awareness


16. I wear a seat belt when traveling in a vehicle.

1 2 3 4 5

17. I stay within five miles per hour of the speed limit.

1 2 3 4 5

18. I know where to locate and properly use a first aid kit and fire extinguisher in case of an emergency.

1 2 3 4 5

19. I use the recommended safety equipment for all activities that I participate in (i.e. mouth guards, life jackets, hard hats, etc.).

1 2 3 4 5

20. I take the proper precautions to avoid or reduce workplace accidents. (i.e. clean up spills)

1 2 3 4 5

Social and Environmental Wellness

21. I regularly recycle my paper, plastic, glass and aluminum.

1 2 3 4 5

22. I respect the integrity and property of my fellow co-workers and the surrounding environment.

1 2 3 4 5

23. I take time to have meaningful interactions with family and friends.

1 2 3 4 5

24. I contribute time and/or money to at least one organization that strives to better the community where I live.

1 2 3 4 5


26. My relationships and behaviors are maintained in a manner which is healthy for me and for others.

1 2 3 4 5

27. I am able to develop close, personal relationships with others.

1 2 3 4 5

28. I have positive relationships with both men and women in my life.

1 2 3 4 5

29. I feel that I am a confident individual.

1 2 3 4 5

30. I am able to respect others for who they are, regardless of race, gender, age, attitude, and interests.

1 2 3 4 5

Mental Wellness

31. I express my feelings of anger and frustration in ways that are not hurtful to myself or others.

1 2 3 4 5

32. I set reasonable objectives for myself and strive to accomplish them.

1 2 3 4 5

33. I realize when I make mistakes; and I understand the consequences that they have on myself and others.

1 2 3 4 5

34. I feel that I have family and friends that I can confide in to assist in managing stress.

1 2 3 4 5


35. I take responsibility for my actions and understand the effects that they have on others.

1 2 3 4 5

Intellectual Wellness

36. I keep informed about social, political, and/or current events.

1 2 3 4 5

37. I seek opportunities to learn new things through different mediums such as television, books, newspaper, internet, etc.

1 2 3 4 5

38. Before making decisions, I gather facts and consider all viable options.

1 2 3 4 5

39. I enjoy activities such as the arts, visiting museums, or attending plays or concerts.

1 2 3 4 5

40. I enjoy learning new information on a daily basis.

1 2 3 4 5

Occupational Wellness

41. I enjoy my work.

1 2 3 4 5

42. I am satisfied with the balance between my work time and leisure time.

1 2 3 4 5


45. At work, my level of authority is consistent with my level of responsibility.

1 2 3 4 5

Values, Spirituality, and Beliefs

46. I feel that my life has a purpose.

1 2 3 4 5

47. I am able to discuss my values and beliefs with my family and friends in a reasonable manner.

1 2 3 4 5

48. My actions are guided by my own beliefs rather than the beliefs of others.

1 2 3 4 5

49. I spend a portion of every day in personal reflection.

1 2 3 4 5

50. I am tolerant of the values and beliefs of others.

1 2 3 4 5


43. I am satisfied with my ability to manage and control my work load.

1 2 3 4 5

44. The level of stress in my work environment is manageable for me.

1 2 3 4 5


Health History And Profile


Most people seek medical help and advice because they experience symptoms of pain, anxiety, fatigue, trouble sleeping or poor digestion. The best results are achieved by treating people not symptoms. The purpose of this questionnaire is to try to know and understand you and the root causes of your symptoms so that you can can become your own healer. The word “doctor” originates from the Latin word “docere”, meaning to teach. Hopefully we can learn from each other and become teachers for a happier healthier life. Please answer the following questions to the best of your ability. We will schedule an interview to make clarifications. Then, after I study all of your information, we will schedule a time to discuss possible causes and a course of action to reduce or eliminate your symptoms and improve your quality of life.

Medical Questionnaire




Phone number:



Blood pressure:



Please make a list of your all your health concerns discussing: 

Onset (when it started)

What makes it worse

What makes it better

Quality (what is it like)

How it affects your life

Severity (on a scale 1 being least and 10 being most)

Timing (when during day or night)

Use a separate paper if needed

What are your health goals

___ Reduce or eliminate symptoms

___ Prevention

___ Achieve optimum health and functioning

1 month goal:

90 day goal:

1 year vision:

5 year vision:



What foods do you crave:

What foods do you avoid:

Describe your eating schedule

Describe the types and amounts of fruits and vegetables you eat daily.

Describe the types of processed carbohydrates, meat and fats (vegetable oils) you eat.


Typical bedtime:

Wake up time:

Average hours of sleep

Quality of sleep

__ Difficulties falling asleep

__ Difficulities staying asleep

Describe your sleeping environment



Room temperature:




Water intake in glasses or ounces per day:


Upsetting daily events:

Major life events:

Relaxation activities:

Community and social activities:

Family support:

Functional review:

Do you breathe through your nose of mouth?

Describe any digestive difficulties such as pain, gas, or bloating. Do you take any anti-acids? 

After eating a meal to about 2/3 fullness what cravings or mood changes do you have?

How often do you urinate and what is the color?

How many bowel movements do you normally have per day?

Is the elimination easy or difficult

Describe the color 

Is this consistency loose, soft or hard?

Is the shape a single form or in pieces?

Is the wipe messy or clean?

Describe how and when you sweat

Please complete the attached medical systems and history review

Are you willing to make life style changes with:

___ Diet

___ Take supplements

___ Exercise

___ Practice relaxation techniques

___ Have lab tests to evaluate your progress

Please bring this questionnaire and copies of the results for your last physical examination and blood tests to our scheduled interview so we can review the information together. 

Thank you

James Brent DDS Health and Wellness

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