This questionnaire asks you to assess how you've been feeling the last four (4) months. This information will help you keep track of how your physical, mental and emotional states respond to changes you make in your eating habits, priorities, supplement program, social and family life, level of physical activity and time spent on personal growth. All information is held in strict confidence. Take all the time you need to complete this questionnaire.
First Name
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Last Name
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Email
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State
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Phone
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Date of birth
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Indigestion, food repeats on you after you eat
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
Excessive burping, belching and/or bloating following meals
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
Stomach spasms and cramping during or after eating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
A sensation that food just sits in your stomach creating uncomfortable fullness, pressure and bloating during or after a meal
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
Bad taste in your mouth
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
Small amounts of food fill you up immediately
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
Skip meals or eat erratically because you have no appetite
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Gastric Function
Strong emotions, or the thought or smell of food aggravates your stomach or makes it hurt
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Feel hungry an hour or two after eating a good sized meal
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Stomach pain, burning and/or aching over a period of 1-4 hours after eating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Stomach pain, burning and/or aching relieved by eating food; drinking carbonated beverages, cream or milk; or taking antacids
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Burning sensation in the lower part of your chest, especially when lying down or bending forward
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Digestive problems that subside with rest and relaxation
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Eating spicy and fatty (fried) foods, chocolate, coffee, alcohol, citrus or hot peppers causes your stomach to burn or ache
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Feel a sense of nausea when you eat
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
Difficulty or pain when swallowing food or beverage
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
GI Inflammation
When massaging under your rib cage on your left side, there is pain, tenderness or soreness
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Indigestion, fullness or tension in your abdomen is delayed, occurring 2-4 hours after eating a meal
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Lower abdominal discomfort is relieved with the passage of gas or with a bowel movement
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Specific foods/beverages aggravate indigestion
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
The consistency or form of your stool changes within the course of a day
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Stool odor is embarrassing
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Undigested food in your stool
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Three or more large bowel movements
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Diarrhea (frequent loose, watery stool)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Small Intestine/Pancreas
Discomfort, pain or cramps in your colon (lower abdominal area)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
Emotional stress and/or eating raw fruits and vegetables causes abdominal bloating, pain, cramps or gas
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
Generally constipated (or straining during bowel movements)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
Stool is small, hard and dry
Yes
No
Colon
Pass mucus in your stool
Yes
No
Colon
Alternate between constipation and diarrhea
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
Rectal pain, itching or cramping
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
No urge to have a bowel movement
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
An almost continual need to have a bowel movement
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Colon
When massaging under your rib cage on your right side, there is pain, tenderness or soreness
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Abdominal pain worsens with deep breathing
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Pain at night that may move to your back or right shoulder
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Bitter fluid repeats after eating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Feel abdominal discomfort or nausea when eating rich, fatty or fried foods
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Throbbing temples and/or dull pain in forehead associated with overeating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Unexplained itchy skin that’s worse at night
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Stool color alternates from clay colored to normal brown
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
General feeling of poor health
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Aching muscles not due to exercise
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Retain fluid and feel swollen around the abdominal area
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Reddened skin, especially palms
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Very strong body odor
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Are you embarrassed by your breath?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Bruise easily
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Yellowish cast to eyes
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hepatobiliary Function
Feel cold or chilled—hands, feet or all over—for no apparent reason
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Your upper eyelids look swollen
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Muscles are weak, cramp and/or tremble
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Are you forgetful?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Do you feel like your heart beats slowly?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Reaction time seems slowed down
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
In general, are you disinterested in sex because your desire is low?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Feel slow-moving, sluggish
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Constipation
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Dryness, discoloration of skin and/or hair
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Have you noticed recently that your voice is deepening?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Thick, brittle nails
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Weight gain for no apparent reason
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Outer third of your eyebrow is thinning or disappearing
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Swelling of the neck
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Thyroid
Lingering mild fatigue after exertion or stress
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Do you find that you get tired and exhaust easily?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Craving for salty foods
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Sensitive to minor changes in weather and surroundings
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Dizzy when rising or standing up from a kneeling position
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Dark bluish or black circles under your eyes
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Have bouts of nausea with or without vomiting
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Catch colds or infections easily
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Wounds heal slowly
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Your body or parts of your body feel tender, sore, sensitive to the touch, hot and/or painful
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Feel puffy and swollen all over your body
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
Skin is gradually tanning without exposure to sun or the ingestion of high levels of carotene-rich foods (e.g., daily carrot juice intake) or supplements
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Adrenal
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? A sense of weakness
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? A sudden sense of anxiety when you get hungry
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Tingling sensation in your hands
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? A sensation of your heart beating too quickly or forcefully
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Shaky, jittery, hands trembling
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Sudden profuse sweating and/or your skin feels clammy
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Nightmares possibly associated with going to bed on an empty stomach
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Wake up at night feeling restless
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Agitation, easily upset, nervous
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Poor memory, forgetful
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Confused or disoriented
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Dizzy, faint
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Cold or numb
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Blurred vision or double vision
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
When you miss meals or go without food for extended periods of time, do you experience any of the following symptoms? Feel clumsy and uncoordinated
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-L
Frequent urination during the day and night
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Unusual thirst—feeling like you can’t drink enough water
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Unusual hunger—eating all the time
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Vision blurs
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Feel itchy all over
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Tingling or numbness in your feet
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Sense of drowsiness, lethargy during the day not associated with missing meals or not sleeping
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Eating starchy foods, even if they are healthy and unprocessed (like rice, corn, beans, whole wheat or oats), causes you to gain weight or prevents you from losing weight
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Sores heal slowly
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Loss of hair on your legs
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Dyglycemia-E
Feel jittery
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
First effort of the day causes pain, pressure, tightness or heaviness around the chest
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
Exhaustion with minor exertion
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
Heavy sweating (no exertion, no hot flashes)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
Difficulty catching breath, especially during exercise
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
Heart pounding, sensation of heart beating too quickly, too slowly or irregularly
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
Swelling in feet, ankles and/or legs comes and goes for no apparent reason
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Heart
Muscle pain at rest
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Cramp-like pains in your ankles, calves or legs
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Numbness, tingling and prickling sensation in hands and feet
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Cold feet and/or toes appear blue
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Brief moments of hearing loss
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Nausea comes and goes quickly (unrelated to eating)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Feel worse standing: legs get heavy and fatigued
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Leg discomfort or fatigue relieved by elevating legs
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Fingers and toes get numb in cold weather even when protected
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Notice changes in your ability to feel pain or differentiate between sensations of hot or cold
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Body hair (on arms, hands, fingers, legs and toes) is thinning or has disappeared
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Do you notice a decline in your ability to make decisions, concentrate, focus attention or follow directions?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Circulation
Family, friends, work, hobbies or activities you hold dear are no longer of interest
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Depression
Do you cry?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Depression
Does life look entirely hopeless?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Depression
Would you describe yourself as feeling miserable and sad, unhappy or blue?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Depression
Do you find it hard to make the best of difficult situations?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Depression
Sleep problems—too much or too little sleep
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Depression
Changes in your appetite and weight
Yes
No
Depression
Lately you've noticed an inability to think clearly or concentrate
Yes
No
Depression
Difficulty making decisions and/or clarifying and achieving your goals
Yes
No
Depression
Does worrying get you down?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Does every little thing get on your nerves and wear you out?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Would you consider yourself a nervous person?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you feel easily agitated?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you shake and tremble?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Are you keyed up and jittery?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you tremble or feel weak when someone shouts at you?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you become scared at sudden movements or noises at night?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you find yourself sighing a lot?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Are you awakened out of your sleep by frightening dreams?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do frightening thoughts keep coming back in your mind?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you become suddenly scared for no reason?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you break out in a cold sweat?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
“Butterflies in your stomach,” nausea and/or diarrhea
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anxiety
Do you feel pent up and ready to explode?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Are you prone to noisy and emotional outbursts?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Do you do things on impulse?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Are you easily upset or irritated?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Do you go to pieces if you don’t control yourself?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Do little annoyances get on your nerves and make you angry?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Does it make you angry to have anyone tell you what to do?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Do you flare up in anger if you can’t have what you want right away?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Anger
Eyes water or tear
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Mucus discharge from the eyes
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Ears ache, itch, feel congested or sore
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Discharge from ears
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Is your nose continually congested?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Are you prone to loud snoring?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Does your nose run?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Nosebleeds
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Hoarse voice
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you have to clear your throat?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you feel a choking lump in your throat?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you suffer from severe colds?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do frequent colds keep you miserable all winter?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Flu symptoms last longer than 5 days
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do infections settle in your lungs?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Chest discomfort or pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you experience sudden breathing difficulties?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you struggle with shortness of breath?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Difficulty exhaling (breathing out)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Breathlessness followed by coughing during exertion, no matter how slight
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Inability to breathe comfortably while lying down
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you cough up lots of phlegm?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Can you hear noisy rattling sounds when breathing in and out?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Are you troubled with coughing?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you wheeze?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you have severe soaking sweats at night?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do your lips and/or nails have a bluish hue?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Are you sleepy during the day?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Do you have difficulty concentrating?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Eyes, ears, nose, throat and lung symptoms seem associated with specific foods like dairy or wheat products
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Eyes, ears, nose, throat and lung symptoms are associated with seasonal changes
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ears, Eyes, Nose, Throat
Involuntary loss of urine when you cough, lift something or strain during an activity
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Mild lower back ache or pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Abdominal achiness or pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Pain or burning when urinating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Rarely feel the urge to urinate
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Feel the need to urinate less than every two hours during the day or night
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Strong smelling urine
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Back or leg pains are associated with dripping after urination
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Urine is a rose color
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Sudden urge to void causes involuntary loss of urine
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Generalized sense of water retention throughout your body
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Kidney and Bladder
Bones throughout your entire body ache, feel tender or sore
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Localized bone pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Hands, feet or throat get tight, spasm or feel numb
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Difficulty sitting straight
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Upper back pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Lower back pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Pain when sitting down or walking
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Find yourself limping or favoring one leg
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Shins hurt during or after exercise
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Bone Integrity
Are you stiff in the morning when you wake up?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Difficulty bending down and picking up clothing or anything from the floor
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Joint swelling, pain or stiffness involving one or more areas (fingers, hands, wrists, elbows, shoulders, toes, arches, feet, ankles, knees or ankles)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Joints hurt when moving or when carrying weight
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
A routine exercise program, like daily walking, causes your knees to swell or hurt
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Difficulty opening jars that were previously easy to open
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Discomfort, numbness, prickling or tingling sensation, or pain in neck, shoulder or arm
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Intermittent pain or ache on one side of head spreading to cheek, temple, lower jaw, ear, neck and shoulder
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Difficulty chewing food or opening mouth
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Difficulty standing up from a sitting position
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Shooting, aching, tingling pain down the back of leg
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Is it difficult to reach up and get a 5-pound object like a bag of flour from just above your head?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Injure, strain or sprain easily
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Connective Tissue
Muscles stiff, sore, tense and/or achy
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Burning, throbbing, shooting or stabbing muscle pain
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Muscle cramps or spasms (involuntary or after exertion/exercise)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Is muscle pain or stiffness greater in the morning than other times of the day?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Specific points on body feel sore when pressed
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Feel unrefreshed upon awakening
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Headaches
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Pain at the sides of your head or in your face especially when awakening
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Your jaw clicks or pops
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Muscle twitch or tremor—eyelids, thumb, calf muscle
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Irresistible urge to move legs
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Legs move during sleep
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Unpleasant crawling sensation inside calves when lying down
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Hand and wrist numbness or pain (e.g., interferes with writing or with buttoning or unbuttoning your clothes)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Feeling of “pins and needles” in your thumb and first three fingers
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Pain in forearm and sometimes in shoulder
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Muscle and Nerves
Head feels heavy
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Dizziness
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Difficulty bending over, standing up from sitting, rolling over in bed and/or turning your head from side to side
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Your hands tremble, ever so slightly, for no apparent reason
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
You feel like you’re wearing heavy weights on your feet when walking
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Bump into things, trip, stumble and feel clumsy
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Difficulty breathing
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Difficulty swallowing
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
People tell you to speak up because they have trouble hearing you
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Speaking and forming words does not feel automatic
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Need 10-12 hours of sleep to feel rested
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Lack strength (your grip is weak, holding your head or picking your arms up takes effort)
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
CNS
Hands get tired when you write and your handwriting is less legible and smaller than it used to be
Yes
No
CNS
Muscles in arms and legs seem softer and smaller
Yes
No
CNS
Is your eyesight, sense of smell and taste or ability to hear not as sharp as it used to be?
Yes
No
CNS
Do you find yourself moving slower than you used to?
Yes
No
CNS
Difficulty absorbing new information
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Tend to forget things
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Trouble thinking or concentrating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Easily distracted
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Do you have a tendency to become frustrated quickly?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Inability to sit still for any length of time, even at mealtime
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Finishing tasks is easier said than done
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Do you have more trouble solving problems or managing your time than usual?
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
Low tolerance for stress and otherwise ordinary problems
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Brain
What is your Gender?
Male
Female
Sensation of not emptying your bladder completely
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Need to urinate less than 2 hours after you have finished urinating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Need to urinate less than 2 hours after you have finished urinating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Find yourself needing to stop and start again several times while urinating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Find it difficult to postpone urination
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Have a weak urinary stream
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Need to push or strain to begin urinating
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Dripping after urination
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Urge to urinate several times a night
No or Rarely -- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally -- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often -- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently -- Symptom occurs 4 or more times per week and/or you are aware of the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Prostate Health
Have you stopped having a menstraul cycle due to menopause?
Yes
No
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Anxious, irritable or restless
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Numbness, tingling in hands and feet
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Easy to anger, resentful
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Aggressive or hostile toward family/friends
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Abdominal bloating, feeling swollen (e.g., feet)
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Temporary weight gain
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Breast tenderness, swelling
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Discharge from nipples
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Nausea and/or vomiting
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Diarrhea or constipation
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Aches and pains (back, joints, etc.)
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Craving for sweets
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Increased appetite or binge eating
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Headaches
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Being easily overwhelmed, shaky or clumsy
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Heart pounding
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Dizziness or fainting
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Confused and forgetful to the point that work suffers
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Overwhelmed with feelings of sadness and worthlessness
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Difficulty sleeping or falling asleep
Yes
No
Premenstrual Balance
Do you persistently experience any of these symptoms within 3 days to 2 weeks prior to menstruation? Engaging in self-destructive behavior
Yes
No
Premenstrual Balance
Do you experience any of these symptoms during your period? Cramping in lower abdomen or pelvic area
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Lower abdominal pain is sharp and/or dull or intermittent
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Bloating and sense of abdominal fullness
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Diarrhea or constipation
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Nausea and/or vomiting
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Low back and/or legs ache
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Headaches
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Unusual fatigue (take naps) resulting in missed work
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Painful and/or swollen breasts
Yes
No
Menstruation
Do you experience any of these symptoms during your period? Scanty blood flow
Yes
No
Menstruation
Painful or difficult sexual intercourse
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Low abdominal, back and vaginal pain throughout the month
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Pelvic pressure or pain while sitting down or standing up, relieved by lying down
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Vaginal bleeding other than during your period
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Painful bowel movements
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Difficult (straining) urination
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Abnormal vaginal discharge
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Offensive vaginal discharge
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Vaginal itching or burning with or without intercourse
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Reproductive Tissue Inflammation
Pain during periods is getting progressively worse
Yes
No
Reproductive Tissue Inflammation
Profuse or prolonged menstrual bleeding
Yes
No
Reproductive Tissue Inflammation
Unable to get pregnant
Yes
No
Reproductive Tissue Inflammation
Absence of periods for six months or longer
Yes
No
Hormone Balance
Periods occur irregularly (e.g., 3 to 6 times a year)
Yes
No
Hormone Balance
Profuse heavy bleeding during periods
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Menstrual blood contains clots and tissue
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Bleeding between periods can occur anytime
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Periods occur greater than every 35 days
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Intense upper stomach pain, lasting several hours at the time you ovulate (approximately day 14 of your cycle)
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Bleeding occurs at ovulation (approximately day 14 of your cycle)
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Monthly abdominal pain without bleeding
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Abundant cervical mucus
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Acne and/or oily skin
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Overwhelming urges for sexual intercourse
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Aggressive feelings
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Hormone Balance
Increased growth of dark facial and/or body hair
Yes
No
Hormone Balance
Poor sense of smell
Yes
No
Hormone Balance
Increased growth of dark facial and/or body hair
Yes
No
Hormone Balance
Voice is becoming deeper
Yes
No
Hormone Balance
Breasts seem to be getting smaller
Yes
No
Hormone Balance
Receding hairline
Yes
No
Hormone Balance
Vaginal discharge
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Vaginal secretions are watery and thin
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Vaginal dryness
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Sexual intercourse is uncomfortable
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Interest in having sex is low
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Engorged breasts
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Breast tenderness, soreness
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Difficulty with orgasm
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Vaginal bleeding after sexual intercourse
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Ovarian Function
Do you skip periods?
Yes
No
Ovarian Function
The length (number of days) of your period varies month to month, with the number of days of bleeding getting fewer
Yes
No
Ovarian Function
Sense of well-being fluctuates throughout the day for no apparent reason
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Sudden hot flashes
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Spontaneous sweating
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Chills
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Cold hands and feet
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Heart beats rapidly or feels like it is fluttering
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Numbness, tingling or prickling sensations
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Dizziness
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Mental fogginess, forgetful or distracted
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Inability to concentrate
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Depression, anxiety, nervousness and/or irritability
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Difficulty sleeping
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Conscious of new feelings of anger and frustration
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Skin, hair, vagina and/or eyes feel dry
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline
Stopped menstruating around six months ago, yet still experience some vaginal bleeding
No or Rarely-- You have never experienced the symptom or the symptom is familiar to you but you perceive it as insignificant (monthly or less)
Occasionally-- Symptom comes and goes and is linked in your mind to stress, diet, fatigue or some identifiable trigger
Often-- Symptom occurs 2-3 times per week and/or with a frequency that bothers you enough that you would like to do something about it
Frequently-- Symptom occurs 4 or more times per week and/or you are aware the symptom every day, or it occurs with regularity on a monthly or cyclical basis
Estrogen/progesterone decline