For your convenience, we have put together this simple quiz to help determine if you could be suffering from Breast Implant Illness. Take the quiz below and a member of our team will reach out to you to discuss your options and how we can help.

Do you have children?

Yes

No

Age of Youngest Child?

<5

5-10

11-15

> 15

Your occupation:

Inside Home

Outside Home

How many years since your (first) breast implant surgery?

<1

1-3

4-7

8-10

11-15

<15

Implant Type?

Saline

Silicone

Unsure

Implant Location

Over Muscle

Under Muscle

Unsure

Implant Surface

Smooth

Textured

Unsure

Do you experience any of these localized breast symptoms?

Breast Pain

Chest Pain

Implant Hardening

Implant Malposition

Swollen Lymph Nodes

Numbness (Nipples/Breast)

Please check if you have any of the diagnoses below

Fibromyalgia

Hashimoto's Thyroiditis

Irritable Bowel Disease

Endocrine Dysfunction

Graves' Disease

Inflammatory Bowel Disease

Hypothyroidism

Lyme Disease

Vitamin D Deficiency

Do you experience any of the following general symptoms?

Brain Fog

Memory Loss

Anxiety

Depression

Chronic Fatique

Chronic Pain

Joint Aches/Pain

Panic Attacks

Do you experience any of the following symptoms?

Vertigo

Visual Disturbances

Ear Ringing

Heart Palpitations

Exercise Intolerance

Easy Bruising

Food Intolerance

Frequent Urination

Leaky Gut

Abdominal Bloating

Irritable Bowel Syndrome

Discoloration of Hands/Feet

Numbness in Feet

Rashes

Headache

Dry Eyes

Body Odor

Shortness of Breath

Fever/Night Sweats

Weight Loss/Gain

Persistent Infections

Frequent UTIs

Acid Reflux

Fungal Infections

Metallic Tastes

Numbness in Hands

Low Libido

Dry Skin

To immediately receive your results, enter your contact information below. We hope this quiz is a helpful first step on your journey towards finding an answer, and we look forward to discussing your situation and working together for a solution.

First Name *

Last Name *

Phone *

Email *

Services

By completing this form, you are giving us permission to follow-up by phone, email or text.