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Symptom Burden Assessment

I start all clients with the Symptom Burden Assessment (estimated time - 30 minutes). This Personalized Health Report allows us to start finding the root cause of your symptoms. 

The Symptom Burden Assessment is a tool that allows us to:

Understand diet and health history, so we don’t repeat previous failed efforts

Assess the total symptom load

Identify health areas of priority

Review symptom burden list

Compare with our client’s primary health concerns

Track overall progress

Click the button below to start.

Start

Question 1 of 342

Please list your top 5 health concerns

Directions

 

Please read the following questions and click the number that applies.

 

Unless otherwise noted, use the default scale shown at the top of each section or page.

 

Trust your instincts and choose quickly without overthinking.

 

Part 1

Section 1: DIET

Question 4 of 342

Alcohol

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 5 of 342

Artificial Sweeteners

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 6 of 342

Candy, Desserts, Sugar

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 7 of 342

Carbonated Beverages

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 8 of 342

Chewing Tobacco

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 9 of 342

Cigarettes

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 10 of 342

Cigars or Pipes

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 11 of 342

Caffeinated Beverages

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 12 of 342

Fast Food

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 13 of 342

Fried Foods

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 14 of 342

Processed Lunch Meats

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 15 of 342

Margarine

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 16 of 342

Milk Products

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 17 of 342

Radiation Exposure

0: No | 1: Yes

A

0

B

1

Question 18 of 342

Refined Flour & Baked Goods

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 19 of 342

Vitamins & Minerals

0: Consume Daily | 1: Consume Weekly| 2: Consume 2-3x/monthly | 3: Do Not Consume

A

0

B

1

C

2

D

3

Question 20 of 342

Distilled Water

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 21 of 342

Tap Water

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 22 of 342

Well Water

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

A

0

B

1

C

2

D

3

Question 23 of 342

Restrict Calories for Weight Control

0: Never Consume | 1: Consume 1-2x/month | 2: Consume Weekly | 3: Consume Daily

 

A

0

B

1

C

2

D

3

Part 1

Section 2: LIFESTYLE

Question 25 of 342

Exercise Sessions Per Week

0: 2+ Times/week | 1: 1 Time/week | 2: 1-2 Times/month | 3: < 1 Time/month

 

A

0

B

1

C

2

D

3

Question 26 of 342

Changed Jobs

0: Over 12 mo. ago | 1: Last 12 mo. | 2: Last 6 mo. | 3: Last 2 mo.

A

0

B

1

C

2

D

3

Question 27 of 342

 Divorced

0: Never or over 2 years ago | 1: Last 2 years | 2: Last year | 3: Last 6 mo.

A

0

B

1

C

2

D

3

Question 28 of 342

Work 60+ Hours Per Week

0: Never | 1: Occasionally | 2: Usually | 3: Always

A

0

B

1

C

2

D

3

Part 1

Section 3: MEDICATIONS

Question 30 of 342

 Antacids

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 31 of 342

Antianxiety Medications

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 32 of 342

Antibiotics

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 33 of 342

Anticonvulsants

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 34 of 342

Antidepressants

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 35 of 342

Antifungals

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 36 of 342

Aspirin/Ibuprofen

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 37 of 342

Asthma Inhalers

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 38 of 342

Beta Blockers

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 39 of 342

Birth Control Pill/Implant

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 40 of 342

Chemotherapy

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 41 of 342

Cholesterol Lowering Medications

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 42 of 342

Cortisone/Steroids

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 43 of 342

Diabetic Medications/Insulin

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 44 of 342

Diuretics

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 45 of 342

Estrogen or Progesterone (Prescript.)

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 46 of 342

Estrogen or Progesterone (Natural)

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 47 of 342

Heart Medications

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 48 of 342

High Blood Pressure Medications

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 49 of 342

Laxatives

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 50 of 342

Recreational Drugs

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 51 of 342

Relaxants/Sleeping Pills

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 52 of 342

Testosterone (Prescript. or Natural)

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 53 of 342

Thyroid Medication

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 54 of 342

Acetaminophen (Tylenol®)

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 55 of 342

Ulcer Medications

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Question 56 of 342

Sildenafil Citrate (Viagra®)

0: No (Not taking or have not taken in the last month) | 1: Yes (Currently taking or have taken in the last month)

A

0

B

1

Part 2

Section 1: Upper G.I

Question 58 of 342

Belching/Gas Within 1 Hour of Eating

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 59 of 342

Heartburn or Acid Reflux

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 60 of 342

Bloating Within 1 Hour of Eating

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 61 of 342

 Vegan Diet

0: No | 1: Yes (No animal products - meat, fish, eggs, dairy, etc.)

A

0

B

1

Question 62 of 342

Bad Breath (Halitosis)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 63 of 342

Loss of Taste for Meat

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 64 of 342

Strong Smelling Sweat

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 65 of 342

Stomach Upset by Taking Vitamins

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 66 of 342

Sense of Excess Fullness After Meals

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 67 of 342

Feel Like Skipping Breakfast

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 68 of 342

Feel Better if You Don’t Eat

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 69 of 342

Sleepy After Meals

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 70 of 342

Fingernails Chip, Peal or Break Easily

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 71 of 342

Anemia Unresponsive to Iron

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 72 of 342

Stomach Pains or Cramps

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 73 of 342

Chronic Diarrhea

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 74 of 342

Diarrhea Shortly After Meals

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 75 of 342

Black or Tarry Colored Stools

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 76 of 342

Undigested Food in Stool

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 2: LIVER AND GALLBLADDER

Question 78 of 342

Pain Between Shoulder Blades

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 79 of 342

Stomach Upset by Greasy Foods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 80 of 342

Greasy or Shiny Stools

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 81 of 342

Nausea

0: No | 1: Yes

A

0

B

1

Question 82 of 342

Motion Sickness (Sea, Car, Airplane)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 83 of 342

History of Morning Sickness

0: No | 1: Yes

A

0

B

1

Question 84 of 342

Light or Clay Colored Stools

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 85 of 342

Dry Skin, Itchy or Peeling Feet

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 86 of 342

Headache Over Eyes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 87 of 342

Gallbladder Attacks

0: Never | 1: Years Ago | 2: Within Last Year | 3: Within Past 3 Months

A

0

B

1

C

2

D

3

Question 88 of 342

Gallbladder Removed

0: No | 1: Yes

A

0

B

1

Question 89 of 342

Bitter Taste in Mouth, Especially After Meals

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 90 of 342

Become Sick When Drinking Wine

0: No | 1: Yes

A

0

B

1

Question 91 of 342

Easily Intoxicated from Wine

0: No | 1: Yes

A

0

B

1

Question 92 of 342

Easily Hungover from Wine

0: No | 1: Yes

A

0

B

1

Question 93 of 342

Alcoholic Beverages Per Week

0: < 3 | 1: < 7 | 2: < 14 | 3: > 14

A

0

B

1

C

2

D

3

Question 94 of 342

Recovering Alcoholic

0: No | 1: Yes

A

0

B

1

Question 95 of 342

History of Drug Abuse

0: No | 1: Yes

A

0

B

1

Question 96 of 342

History of Hepatitis

0: No | 1: Yes

A

0

B

1

Question 97 of 342

Long-term Use of Prescript./Rec. Drugs

0: No | 1: Yes 

 

A

0

B

1

Question 98 of 342

Sensitive to Chemicals (e.g. Perfume, Cleaning Agents, etc.)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 99 of 342

Sensitive to Tobacco Smoke

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 100 of 342

Exposure to Diesel Fumes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 101 of 342

Pain Under Right Side of Rib Cage

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 102 of 342

Hemorrhoids or Varicose Veins

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 103 of 342

Consume NutraSweet® (Aspartame)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 104 of 342

Sensitive to Aspartame

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 105 of 342

Chronic Fatigue or Fibromyalgia

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 3: SMALL INTESTINE

Question 107 of 342

Food Allergies

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 108 of 342

Abdominal Bloating 1-2 Hours After Meal

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 109 of 342

Specific Foods Make You Tired / Bloated

0: No | 1: Yes

A

0

B

1

Question 110 of 342

Pulse Speeds After Eating

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 111 of 342

Airborne Allergies

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 112 of 342

Experience Hives

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 113 of 342

Sinus Congestion, “Stuffy Head”

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 114 of 342

Crave Bread or Noodles

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 115 of 342

Alternating Constipation/Diarrhea

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 116 of 342

Crohn’s Disease

0: No | 1: Yes in the Past | 2: Currently Mild | 3: Currently Severe

A

0

B

1

C

2

D

3

Question 117 of 342

Wheat or Grain Sensitivity

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 118 of 342

Dairy Sensitivity

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 119 of 342

Are There Any Foods You Can’t Give Up?

0: No | 1: Yes

A

0

B

1

Question 120 of 342

Asthma, Sinus Infections, Stuffy Nose

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 121 of 342

Bizarre, Vivid Dreams; Nightmares

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 122 of 342

Use Over-the-Counter Pain Meds

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 123 of 342

Feel Spacey or Unreal

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 4: LARGE INTESTINE

Question 125 of 342

Anus Itches

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 126 of 342

Coated Tongue

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 127 of 342

Feel Worse in Moldy/Musty Places

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 128 of 342

Total Antibiotic Use

0: Never | 1: Less than 1 Month | 2: Less than 3 Months | 3: More than 3 Months

A

0

B

1

C

2

D

3

Question 129 of 342

Fungal or Yeast Infections

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 130 of 342

Ring Worm, Jock Itch, Athletes Foot, Nail Fungus

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 131 of 342

Yeast Symptoms Increase with Sugar, Starch, or Alcohol Consumption

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 132 of 342

Hard or Difficult to Pass Stool

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 133 of 342

History of Parasites

0: No | 1: Yes

A

0

B

1

Question 134 of 342

Less Than 1 Bowel Movement/Day

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 135 of 342

Stools Have Corners/Edges, are Flat, or Ribbon Shaped

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 136 of 342

Stools are Not Well Formed (Loose)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 137 of 342

Irritable Bowel or Mucus Colitis

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 138 of 342

Blood in Stool

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 139 of 342

Mucus in Stool

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 140 of 342

Excessive, Foul Smelling Flatulence

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 141 of 342

Bad Breath or Strong Body Odors

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 142 of 342

Painful to Press Along Outer Thighs (Iliotibial Bands)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 143 of 342

Cramps in Lower Abdominal Region

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 144 of 342

Dark Circles Under Eyes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 5: MINERAL NEEDS

Question 146 of 342

History of Carpal Tunnel Syndrome

0: No | 1: Yes

A

0

B

1

Question 147 of 342

History of Lower Right Abdominal Pains or Ileocecal Valve Problems

0: No | 1: Yes

A

0

B

1

Question 148 of 342

History of Stress Fracture

0: No | 1: Yes

A

0

B

1

Question 149 of 342

Bone Loss (Reduced Density on Bone Scan)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 150 of 342

Are You Shorter Than You Used to Be?

0: No | 1: Yes

A

0

B

1

Question 151 of 342

Calf, Foot, or Toe Cramps at Rest

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 152 of 342

Cold Sores, Fever Blisters, or Herpes Lesions

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 153 of 342

Frequent Fevers

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 154 of 342

Frequent Skin Rashes or Hives

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 155 of 342

Herniated Disc

0: No | 1: Yes

A

0

B

1

Question 156 of 342

Excessively Flexible Joints / “Double Jointed”

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 157 of 342

Joints Pop or Click

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 158 of 342

Pain or Swelling in Joints

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 159 of 342

Bursitis or Tendonitis

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 160 of 342

History of Bone Spurs

0: No| 1: Yes

A

0

B

1

Question 161 of 342

Morning Stiffness

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 162 of 342

Nausea with Vomiting

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 163 of 342

Crave Chocolate

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 164 of 342

Feet Have a Strong Odor

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 165 of 342

History of Anemia

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 166 of 342

Whites of Eyes (Sclera) are Blue Tinted

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 167 of 342

Hoarseness

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 168 of 342

Difficulty Swallowing

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 169 of 342

Lump in Throat

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 170 of 342

Dry Mouth, Eyes, or Nose

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 171 of 342

Gag Easily

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 172 of 342

White Spots on Fingernails

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 173 of 342

Cuts Heal Slowly and/or Scar Easily

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 174 of 342

Decreased Sense of Taste or Smell

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 6: FATTY ACIDS

Question 176 of 342

Experience Pain Relief with Aspirin

0: No | 1: Yes

A

0

B

1

Question 177 of 342

Crave Fatty or Greasy Foods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 178 of 342

Low-Fat or Reduced-Fat Diet

0: Never | 1: Years Ago | 2: Within Past Year | 3: Currently

A

0

B

1

C

2

D

3

Question 179 of 342

Tension Headaches at Base of Skull

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 180 of 342

Headaches When Out in the Hot Sun

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 181 of 342

Sunburn Easily or Get “Sun Poisoning”

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 182 of 342

Muscles Easily Fatigued

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 183 of 342

Dry, Flaky Skin or Dandruff

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 7: SUGAR HANDLING

Question 185 of 342

Awaken a Few Hours After Falling Asleep & Have Difficulty Falling Back to Sleep

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 186 of 342

Crave Sweets

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 187 of 342

Binging or Uncontrolled Eating

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 188 of 342

Excessive Appetite

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 189 of 342

Crave Coffee or Sugar in the Afternoon

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 190 of 342

Sleep in the Afternoon

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 191 of 342

Fatigue that is Relieved by Eating

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 192 of 342

Headache if Meals are Skipped / Delayed

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 193 of 342

Irritable Before Meals

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 194 of 342

Shaky if Meals are Delayed

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 195 of 342

Family Members with Diabetes

0: No | 1: Yes

A

0

B

1

Question 196 of 342

Frequent Thirst

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 197 of 342

Frequent Urination

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 8: VITAMIN NEEDS

Question 199 of 342

Muscles Become Easily Fatigued

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 200 of 342

Feel Exhausted or Sore After Moderate Exercise

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 201 of 342

Vulnerable to Insect Bites

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 202 of 342

Loss of Muscle Tone, Heaviness in Arms/Legs

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 203 of 342

Enlarged Heart or Congestive Heart Failure

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 204 of 342

Pulse Below 65 Beats Per Minute

0: No | 1: Yes

A

0

B

1

Question 205 of 342

Ringing in the Ears (Tinnitus)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 206 of 342

Numbness, Tingling, or Itching in Hands & Feet

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 207 of 342

Depressed

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 208 of 342

Fear of Impending Doom

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 209 of 342

Worrier, Apprehensive, Anxious

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 210 of 342

Nervous or Agitated

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 211 of 342

Feelings of Insecurity

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 212 of 342

Heart Races

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 213 of 342

Can Hear Heartbeat on Pillow at Night

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 214 of 342

Whole Body or Limb Jerk as Falling Asleep

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 215 of 342

Night Sweats

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 216 of 342

Restless Leg Syndrome

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 217 of 342

Cracks at Corner of Mouth (Cheilosis)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 218 of 342

Fragile, Easily Chaffed Skin (e.g. When Shaving)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 219 of 342

Polyps or Warts

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 220 of 342

MSG Sensitivity

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 221 of 342

Wake Up Without Remembering Dreams

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 222 of 342

Small Bumps on Back of Arms

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 223 of 342

Strong Light at Night Irritates Eyes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 224 of 342

Nose Bleeds and/or Tends to Bruise Easily

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 225 of 342

Bleeding Gums, Especially When Brushing

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 9: ADRENALS

Question 227 of 342

Tend to be a “Night Person”

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 228 of 342

Difficulty Falling Asleep

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 229 of 342

Slow Starter in the Morning

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 230 of 342

Tend to be “Keyed Up”, Trouble Calming Down

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 231 of 342

Blood Pressure Above 120/80

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 232 of 342

Headache After Exercising

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 233 of 342

Feeling Wired or Jittery After Drinking Coffee

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 234 of 342

Clench or Grind Teeth

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 235 of 342

Calm on the Outside, Troubled on the Inside

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 236 of 342

Chronic Lower Back Pain, Worse with Fatigue

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 237 of 342

Become Dizzy When Standing Up Quickly

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 238 of 342

Difficulty Maintaining Manipulative Correction

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 239 of 342

Pain After Manipulative Correction

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 240 of 342

Arthritic Tendencies

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 241 of 342

Crave Salty Foods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 242 of 342

Salt Foods Before Tasting

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 243 of 342

Perspire Easily

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 244 of 342

Chronic Fatigue or Get Drowsy Often

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 245 of 342

Afternoon Yawning

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 246 of 342

Afternoon Headache

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 247 of 342

Asthma, Wheezing, or Difficulty Breathing

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 248 of 342

Pain on the Medial or Inner Side of Knee

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 249 of 342

Tendency to Sprain Ankles or Get “Shin Splints”

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 250 of 342

Tendency to Need Sunglasses

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 251 of 342

Allergies and/or Hives

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 252 of 342

Weakness, Dizziness

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 10: PITUITARY

Question 254 of 342

Height Over 6’ 6”

0: No | 1: Yes

A

0

B

1

Question 255 of 342

Early Sexual Development (Before Age 10)

0: No | 1: Yes

A

0

B

1

Question 256 of 342

Increased Libido

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 257 of 342

Splitting Type Headache

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 258 of 342

Memory Failing

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 259 of 342

Tolerate / Feel Fine When Eating Sugar

0: No | 1: Yes

A

0

B

1

Question 260 of 342

Height Under 4’ 10”

0: No | 1: Yes

A

0

B

1

Question 261 of 342

Decreased Libido

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 262 of 342

Excessive Thirst

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 263 of 342

Weight Gain Around Hips or Waist

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 264 of 342

Menstrual Disorders

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 265 of 342

Delayed Sexual Development (After Age 13)

0: No | 1: Yes

A

0

B

1

Question 266 of 342

Tendency to Ulcers or Colitis

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 11: THYROID

Question 268 of 342

Sensitive/Allergic to Iodine

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 269 of 342

Difficulty Gaining Weight (Even With Large Appetite)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 270 of 342

Nervous or Emotional (Can’t Work Under Pressure)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 271 of 342

Inward Trembling

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 272 of 342

Flush Easily

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 273 of 342

Fast Pulse at Rest

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 274 of 342

Intolerance to High Temperatures

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 275 of 342

Difficulty Losing Weight

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 276 of 342

Mentally Sluggish / Reduced Initiative

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 277 of 342

Easily Fatigued / Sleepy During the Day

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 278 of 342

Sensitive to Cold / Poor Circulation (Cold Hands & Feet)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 279 of 342

Chronic Constipation

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 280 of 342

Excessive Hair Loss and/or Course Hair

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 281 of 342

Morning Headaches (Wear Off During the Day)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 282 of 342

Loss of Lateral (Outside) 1⁄3 of Eyebrow

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 283 of 342

Seasonal Sadness

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 12: MEN ONLY

Question 285 of 342

Prostate Problems

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 286 of 342

Difficulty with Urination / Dribbling

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 287 of 342

Difficult to Start & Stop Urine Stream

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 288 of 342

Pain or Burning During Urination

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 289 of 342

Waking to Urinate at Night

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 290 of 342

Interruption of Stream During Urination

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 291 of 342

Pain on Inside of Legs or Heels

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 292 of 342

Feeling of Incomplete Bowel Evacuation

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 293 of 342

Decreased Sexual Function (Dysfunction related to prostate issues only)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 13: WOMEN ONLY

If you are in menopause or no longer menstruating, please indicate the average symptoms that occurred when you were last menstruating.

Question 295 of 342

Depression During Periods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 296 of 342

Mood Swings Associated with Periods (Premenstrual Syndrome)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 297 of 342

Crave Chocolate Around Periods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 298 of 342

Breast Tenderness Associated with Cycle

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 299 of 342

Excessive Menstrual Flow

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 300 of 342

Scanty Blood Flow During Periods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 301 of 342

Occasional Skipped Periods

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 302 of 342

Variations in Menstrual Cycles

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 303 of 342

Endometriosis

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 304 of 342

Uterine Fibroids

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 305 of 342

Breast Fibroids / Benign Masses

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 306 of 342

Painful Intercourse (Dyspareunia)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 307 of 342

Vaginal Discharge

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 308 of 342

Vaginal Dryness

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 309 of 342

Vaginal Itchiness

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 310 of 342

Tendency to gain weight around hips, thighs and buttocks as opposed to other areas such as the mid-section

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 311 of 342

Excess Facial or Body Hair

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 312 of 342

Hot Flashes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 313 of 342

Night Sweats (in Menopausal Women)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 314 of 342

Thinning Skin

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 14: CARDIOVASCULAR

Question 316 of 342

Aware of Heavy or Irregular Breathing

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 317 of 342

Discomfort at High Altitudes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 318 of 342

“Air Hunger” or Sigh Frequently

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 319 of 342

Compelled to Open Windows in a Closed Room

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 320 of 342

Shortness of Breath with Moderate Exertion

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 321 of 342

Ankles Swell, Especially at End of Day

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 322 of 342

Cough at Night

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 323 of 342

Blush / Face Turns Red for No Reason

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 324 of 342

Dull Pain or Tightness in Chest and/or Radiating Into Right Arm (Worse with Exertion)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 325 of 342

Muscle Cramps with Exertion

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 15: KIDNEY & BLADDER

Question 327 of 342

Pain in Mid-Back Region

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 328 of 342

Puffy / Dark Circles Around the Eyes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 329 of 342

History of Kidney Stones

0: No | 1: Yes

A

0

B

1

Question 330 of 342

Cloudy, Bloody, or Darkened Urine

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 331 of 342

Urine Has a Strong Odor

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Part 2

Section 16: IMMUNE SYSTEM

Question 333 of 342

Runny or Drippy Nose

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 334 of 342

Catch Colds at the Beginning of Winter

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 335 of 342

Mucus Producing Cough

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 336 of 342

Frequent Colds or Flu

0: 1 or less per year | 1: 2-3 per year | 2: 4-5 per year (weekly) | 3: 6 or more per year

A

0

B

1

C

2

D

3

Question 337 of 342

Other Infections (e.g. Sinur, Ear, Lung, Skin, Bladder, Kidney, etc.)

0: 1 or less per year | 1: 2-3 per year | 2: 4-5 per year (weekly) | 3: 6 or more per year

A

0

B

1

C

2

D

3

Question 338 of 342

Never Get Sick

0: sick only 1 or 2 times in last 2 years | 1: not sick in last 2 years | 2: not sick in last 4 years | 3: 6 not sick in last 7 years

A

0

B

1

C

2

D

3

Question 339 of 342

Adult Acne

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 340 of 342

Itchy Skin (Dermatitis)

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 341 of 342

Cysts, Boils, or Rashes

0: Never Occurs | 1: Minor; Rarely Occurs (1x/month) | 2: Moderate; Occasionally (weekly) | 3: Severe; Frequent (daily)

A

0

B

1

C

2

D

3

Question 342 of 342

History of Chronic Viral Condition (e.g. Mono, Epstein Bar, Herpes, Shingles, Chronic Fatigue Syndrome)

0: No | 1: Yes in the Past | 2: Currently Mild Condition | 3: Severe

A

0

B

1

C

2

D

3

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