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About Oxford
About Oxford
Scientific Team / Medical Advisory Board
Management
Food Reactivity
Understanding Diet-Induced Inflammation
How Sensitivities Cause Inflammation
Leaky Gut and Sensitivity
Mediator Release Test
MRT III: The Future of Sensitivity Testing
The Patented Mediator Release Test
Collaboration with Sony Biotechnology, Inc.
MRT Food & Chemical Profiles
Specimen Collection & Shipping
Research
Oxford Clinical & Technical Research
Publications & Research
IBS Research Study
IBD Research Study
Collaborate In Research
LEAP
How LEAP Works
Eating Plan Frequently Asked Questions
LEAP In The News
Patient Experiences
CLT Training
What CLTs Say
CLT Course Description
Pre-Purchase the Certified LEAP Therapist Training Course
LEAP Mentors
Contact Oxford
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Complimentary Patient Prescreening
Please fill out our Complimentary Patient Prescreening Form below with all your info.
Company
Lead Type
-None-
Prac Lead
CLT Practice Lead
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Lead Source
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Lead Stage
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Last Name
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How did you first hear about MRT?
First Name
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Male/Female
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-None-
Male
Female
Date Of Birth
Height (Inches)
Weight (lbs)
Is There A History of Allergies in your Family?
What are your main health complaints (In Order of Importance)
List All Medications (Prescription & OTC) Currently Taken on Regular or as Needed Basis
SCALE OF SYMPTOMS SUFFERED DURING THE LAST SIX (6) MONTHS
Select option
0
If You Do Not Suffer From This
AT ALL
Select option
1
If You Suffer
Occasionally
(less than twice a week) and It Is
Not Severe
Select option
2
If You Suffer
Frequently
(2 or more times per week) and It Is
Not Severe
Select option
3
If You Suffer
Occasionally
(less than twice a week) and When You Do It Is
Severe
Select option
4
If You Suffer
Frequently
(2 or more times per week) and When You Do It Is
Severe
CONSTITUTIONAL SYMPTOMS
Fatigue (tired, sluggish)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Hyperactive (nervous energy)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Restless (can’t relax/sit still)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Sleepiness during day
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Insomnia at night
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Malaise (feel lousy)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
LUNGS
“Wheezing” (Asthma/ Asthma-Like Symptoms)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Chest Congestion
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
“Non-Productive” Coughing
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
“Productive” Coughing
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
EMOTIONAL/MENTAL SYMPTOMS
Depression (feelings of hopelessness)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Anxiety (vague fears, uneasiness)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Mood Swings (rapid, distinct changes)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Irritability (anger, hostility)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Forgetfulness
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Lack of Concentration/Focus
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
EYES
Red or Swollen Eyes
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Watery Eyes
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Itchy Eyes
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
“Dark Circles” or “Baggy” Eyes
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
GENITOURINARY
Increased Urinary Frequency
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Painful Urination
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
HEAD/EARS
Headache (any kind)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Earache
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Ear Infection
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Ringing in Ear
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Itchy Ears
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Discharge from Ear
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
MUSCULOSKELETAL
Joint Pains/Aching
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Stiff Joints
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Muscle Aches
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Stiff Muscles
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Arthritis (Diagnosed)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
SKIN
Skin Blemishes, Acne
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Rashes, Hives
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Eczema
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
“Rosy” Cheeks
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
CARDIOVASCULAR
Irregular Heartbeat
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
High Blood Pressure (Diagnosed)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
NASAL/SINUS
Post Nasal Drip
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Sinus Pain
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Runny Nose
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Stuffy Nose
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Sneezing
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
DIGESTIVE
Heartburn/Esoph. Reflux
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Stomach Pains/Cramps
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Intestinal Pains/Cramps
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Constipation
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Diarrhea
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Bloating Sensation
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Gas (of Any Kind)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Nausea, Vomiting
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Painful Elimination
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
MOUTH/THROAT
Sore Throat
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Swollen Throat
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Swelling of Lips/Tongue
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Gagging or Throat “Clearing”
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Lesions (“Canker Sores”)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
WEIGHT MANAGEMENT
Overweight
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Fluctuating Weight
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Food Cravings
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Water Retention
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Binge Eating or Drinking
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
Purging (all methods)
-None-
0 Do Not Suffer From
1 Occasionally (less than twice a week) And Not Severe
2 Frequently (2 or more times per week) And Not Severe
3 Occasionally (less than twice a week) And Severe
4 Frequently (2 or more times per week) And Severe
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