| SYMPTOMS: MIND: EMOTIONAL |
| 425. |
How large and available is your social support group - the circle of close friends / family that you can confide in and turn to for support? |
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| 426. |
Does being emotionally upset result in exhaustion? |
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| 427. |
Overall, how stressful is your lifestyle? |
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| 428. |
Do you have trouble working under pressure? |
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| 429. |
Do you collapse or go into shock from too much stress? |
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| 430. |
Have you had a problem with panic attacks? |
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| 431. |
Worry / anxiety. Do you tend to be...? |
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| 432. |
Are you experiencing any form of anguish, grief, or heartbreak? |
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| 433. |
Have you had suicide thoughts or attempts? |
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| 434. |
Have you recently endured the death of a loved one? |
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| 435. |
Do you have fears or phobias? |
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| 436. |
Do you have difficult memories of traumatic experiences? Do not include rape or sexual / physical abuse as these will be covered separately. |
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| 437. |
Do you cry or become teary / sad for no reason? |
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| 438. |
As far as you know, has depression or a depressive tendency been a problem for you? This includes seasonal or recurring episodes but not depression associated specific events such as (for women) menstrual periods or giving birth. |
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| 439. |
Approximately how often do you have feelings of insecurity? Examples include worrying about what people think of you, or wondering if you are working hard enough. |
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| 440. |
How would you rate your irritability or usual level of irritation? |
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| 441. |
Disposition. Are you...? |
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| 442. |
Are you generally moody and somewhat emotional by nature? |
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| 443. |
How would you rate your emotional stability? |
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| 444. |
Have you had any nervous breakdowns? |
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Add any additional information here for the questions above:
Please mention the question number(s) if possible.
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| SYMPTOMS: GLANDULAR |
| 445. |
Do you have diabetes? |
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| 446. |
Do you suffer from Hypoglycemia (abnormally low blood glucose level)? |
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| 447. |
Hyperthyroidism |
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| 448. |
Hypothyroidism |
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| 449. |
Do you have a swelling at the front of your neck? |
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| 450. |
Adrenal Insufficiency |
|
| 451. |
Have you had any swollen, tender or painful lymph nodes within the past year? They appear as small, smooth lumps under the skin. If in doubt, click on the link to read more about them. |
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Add any additional information here for the questions above:
Please mention the question number(s) if possible.
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| SYMPTOMS: METABOLIC |
| 452. |
If you are hyperactive, are you also generally exhausted? |
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| 453. |
Do you suffer from the incurable genetic lung disease known as cystic fibrosis? |
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| 454. |
How would you rate your physical stamina (ability to undertake prolonged exercise)? |
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| 455. |
Do you ever feel cold for no apparent reason? |
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| 456. |
Do you experience inappropriate / excessive sweating during the day? Only include sweating that is not explained by a hot / humid climate, exertion or dressing too warmly. |
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| 457. |
Do your feet tend to have a strong odor and/or sweat a lot? |
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| 458. |
Do you suffer from edema (swelling/puffiness caused by fluid retention) anywhere on your body? |
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| 459. |
Do you find that flu / influenza stays longer and hits harder than for other people? |
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| 460. |
Do you have frequent colds or flus? |
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| 461. |
Do you currently have a fever? If you do, try to rate your average temperature. |
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| 462. |
How often do you get unexplained fevers? |
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| 463. |
If you suffer from unexplained recurring fever, how would you rate its average severity? |
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| 464. |
Do you sometimes experience 'chills' (sensations of cold accompanied by shivering) that can not be explained by your environment? |
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| 465. |
Have headaches been a problem for you? |
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| 466. |
Have you experienced any unusual headaches within the past month? |
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| 467. |
Do you feel shaky, headachy, tired, faint or nauseated when meals are delayed? |
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| 468. |
Do you experience inner trembling? |
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| 469. |
Have you suffered from pancreatitis? |
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| 470. |
Does your body temperature, during the day and under normal conditions, sometimes measure below 98.0°F (36.7°C)? Only answer this if you are confident that your answer is accurate. |
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| 471. |
What is your approximate percentage body fat? |
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| 472. |
Do you have any problems with your weight? This includes being under/overweight, difficulty maintaining weight, a history of serious weight gains and losses, recent unexplained weight changes, etc. |
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Add any additional information here for the questions above:
Please mention the question number(s) if possible.
|
| SYMPTOMS: URINARY |
| 473. |
Have you suffered from interstitial cystitis (debilitating chronic pain characterized by urinary urgency, frequency, urination at night and bladder pain)? |
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| 474. |
Have you had a bladder infection? Symptoms are similar to those of interstitial cystitis except that it is much more common, of shorter duration and generally resolves by itself or with treatment. |
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| 475. |
Have you suffered from kidney stones? |
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| 476. |
Do you have any degree of chronic renal insufficiency or kidney failure? |
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| 477. |
Do you dribble significantly after voiding urine? |
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| 478. |
Do you have a problem with urine leakage (incontinence)? |
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| 479. |
Do you have internal pain or discomfort in the inguinal (groin) area? |
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| 480. |
Is there an interruption of the stream while urinating? |
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| 481. |
How difficult or easy is it for you to urinate? In other words, how forceful is your urine stream? |
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| 482. |
Urination. On average, how many times do you get up to urinate during your sleeping hours? |
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| 483. |
Urination. On average, how many times do you urinate during waking hours? |
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| 484. |
Do you feel a frequent need to urinate, even when your bladder is empty? |
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| 485. |
What is the usual color of your urine, ignoring supplement (B-vitamin) yellowing, medications you are taking or other obvious factors? |
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| 486. |
Is your urine cloudy? |
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| 487. |
Do you ever see blood in your urine? |
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| 488. |
When you urinate, is foam produced in the toilet? This is known as 'foamy urine'. |
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| 489. |
Do you suffer pain or burning while urinating? |
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| 490. |
Do you have any form of unusual urethral discharge? |
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| 491. |
Does your urine usually have a strong odor? |
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Add any additional information here for the questions above:
Please mention the question number(s) if possible.
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SYMPTOMS: REPRODUCTIVE
Some of the questions below are personal in nature. If you are unwilling to answer a question, skip it by leaving the default "don't know" response. |
| 492. |
At what age did you become sexually active? |
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| 493. |
What is the approximate number of sexual partners that you have had during your lifetime? |
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| 494. |
Is your sexual desire (libido)... ? |
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| 495. |
Frequency of sex |
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| 496. |
How frequently do you experience premature ejaculation? |
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| 497. |
Have you had a vasectomy? |
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| 498. |
Do you have difficulty getting an erection? |
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| 499. |
Do you suffer from poor erection maintenance? |
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| 500. |
Do you have Peyronie's disease (a bend in the erect penis, a lump in the penis when flaccid, and/or pain during erection)? |
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| 501. |
Have you been diagnosed with an enlarged prostate? |
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| 502. |
Prostatitis |
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| 503. |
Do you have any genital sores or lesions? |
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| 504. |
Do you have any wart-like fleshy bumps in or around the anus, penis, groin, or scrotal area? They may bleed when irritated, and may occur individually or merge to form small cauliflower-like clusters. |
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| 505. |
What is your HIV/AIDS risk/status? |
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| 506. |
Other than AIDS, have you had any form of sexually-transmitted disease (STD)? |
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Add any additional information here for the questions above:
Please mention the question number(s) if possible.
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