Symptom Review Questionnaire (SRQ) Web Application Signup Form

Fill Out the Following Form So We Can Create Your Own Secure SRQ Portal  – Setup Complete Within 24 hours

In 2012 Dr. Dick Versendaal wrote nutritional/essential oil protocols for over 250 symptoms and syndromes, including a spinal focus and when to support the feet. These were used to create the SRQ, Symptom Review Questionnaire, a web application that allows you to create a unique management program for each person under your care.


  • An email confirmation and SRQ instructions will be sent to this email address.
  • First NameLast NameEmailPasswordBirthday (MMDD) 
    Click the plus button to add more professionals.
  • Accepted file types: jpg.