Questionnaire Index

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FEMALE questionnaire

(Click here for male questionnaire)
Page 1 Personal Background Symptoms General Food Eating Dieting Symptoms Muscular Symptoms Skeletal Symptoms Nervous Symptoms Liver Gallbladder Symptoms Bowel Movements
Page 1(a) Doctor Visits Within Past Year
Page 1(b) Tropical Travel
Page 1(c) Fatigue
Page 1(d) Weight-Loss Diets
Page 1(e) Eating Issues
Page 1(f) Muscular Symptoms
Page 1(g) Twitching And Cramping
Page 1(h) Morning Stiffness
Page 1(i) Neck And Back Problems
Page 1(j) Neck Problems
Page 1(k) Joint Problems
Page 1(l) Limb Problems
Page 1(m) Unusual Skin Sensations
Page 1(n) Gallbladder Problems
Page 1(o) Liver Problems
Page 1(p) Unusual Bowel Movements
Page 2 Symptoms Gast-Int General Symptoms Mouth Symptoms Eyes General Symptoms Ears General Symptoms Nose
Page 2(a) Digestive Problems
Page 2(b) Problems After Eating
Page 2(c) Abdominal Problems
Page 2(d) Abdomen Pain Even Without Food
Page 2(e) Abdomen Pain After Eating
Page 2(f) Abdomen Pain Worse After Meals
Page 2(g) Bowel Problems
Page 2(h) Parasites
Page 2(i) Symptoms Missing Teeth
Page 2(j) Symptoms Mouth Specific
Page 2(k) Nearsightedness/Farsightedness
Page 2(l) Symptoms Eyes Specific
Page 2(m) Symptoms Ears Specific
Page 3 Symptoms Mind General Symptoms Mind Emotional Symptoms Glandular
Page 3(a) Mental Conditions
Page 3(b) Major Life Changes
Page 3(c) Depression
Page 3(d) Diabetes
Page 3(e) Symptoms Lymph Nodes
Page 4 Symptoms Metabolic Symptoms Urinary Symptoms Female Symptoms Reproductive
Page 4(a) Symptoms Edema
Page 4(b) Headaches
Page 4(c) Weight Problems
Page 4(d) Pregnancy Experience
Page 4(e) Past Pregnancies
Page 4(f) Current Pregnancy
Page 4(g) Unusual Vaginal Symptoms
Page 4(h) Unusual Vaginal Discharge
Page 4(i) Pre-Menopause
Page 4(j) Post-Menopause
Page 4(k) Symptoms STDs
Page 5 Symptoms Respiratory Symptoms Sleep Symptoms Cardiovascular Symptoms Immune System Symptoms Skin General
Page 5(a) Breathing Difficulty
Page 5(b) Chest Discomfort
Page 5(c) Sleep Problems
Page 5(d) Heart Problems
Page 5(e) Anemia
Page 5(f) Symptoms Cancers Additional Cancer Questions
Page 6 Symptoms Skin Conditions Symptoms Hair Symptoms Nails Lifestyle And Exercise
Page 6(a) Symptoms Nipples
Page 6(b) Symptoms Nail Abnormalities
Page 7 Diet Food Preferences Liquid Intake Environmental Exposure
Page 7(a) Vegan Diet
Page 7(b) Alcohol
Page 7(c) Coffee And Tea
Page 7(d) Soft Drinks
Page 7(e) Tobacco Use
Page 7(f) Hazardous Substances
Page 7(g) Allergic And Adverse Reactions
Page 7(h) Reaction To Cold Damp Weather
Page 8 Symptoms Aging Supplements And Medications Medical Procedures Common Lab Values Family History Childhood
Page 8(a) Nutritional Supplements
Page 8(b) Antacid Use
Page 8(c) Prescription Antibiotic Use
Page 8(d) Psychotropic Drug Use
Page 8(e) Hormone Use
Page 8(f) Natural Progesterone Use
Page 8(g) Laxative Use
Page 8(h) Pain Medication
Page 8(i) Anti-inflammatory Use
Page 8(j) Recreational Drugs
Page 8(k) Miscellaneous Medications
Page 8(l) Past Surgeries
Page 8(m) Lab Values Cells Lab Values Chemistries Lab Values Hormones Lab Values Nutrients Lab Values Scans Other Diagnostic Tests
Page 8(n) Family History
Page 9 Contact Details Height, Weight Further Information, Comments

MALE questionnaire

(Click here for female questionnaire)
Page 1 Personal Background Symptoms General Food Eating Dieting Symptoms Muscular Symptoms Skeletal Symptoms Nervous Symptoms Liver Gallbladder Symptoms Bowel Movements
Page 1(a) Doctor Visits Within Past Year
Page 1(b) Tropical Travel
Page 1(c) Fatigue
Page 1(d) Weight-Loss Diets
Page 1(e) Eating Issues
Page 1(f) Muscular Symptoms
Page 1(g) Twitching And Cramping
Page 1(h) Morning Stiffness
Page 1(i) Neck And Back Problems
Page 1(j) Neck Problems
Page 1(k) Joint Problems
Page 1(l) Limb Problems
Page 1(m) Unusual Skin Sensations
Page 1(n) Gallbladder Problems
Page 1(o) Liver Problems
Page 1(p) Unusual Bowel Movements
Page 2 Symptoms Gast-Int General Symptoms Mouth Symptoms Eyes General Symptoms Ears General Symptoms Nose
Page 2(a) Digestive Problems
Page 2(b) Problems After Eating
Page 2(c) Abdominal Problems
Page 2(d) Abdomen Pain Even Without Food
Page 2(e) Abdomen Pain After Eating
Page 2(f) Abdomen Pain Worse After Meals
Page 2(g) Bowel Problems
Page 2(h) Parasites
Page 2(i) Symptoms Missing Teeth
Page 2(j) Symptoms Mouth Specific
Page 2(k) Nearsightedness/Farsightedness
Page 2(l) Symptoms Eyes Specific
Page 2(m) Symptoms Ears Specific
Page 3 Symptoms Mind General Symptoms Mind Emotional Symptoms Glandular
Page 3(a) Mental Conditions
Page 3(b) Major Life Changes
Page 3(c) Depression
Page 3(d) Diabetes
Page 3(e) Symptoms Lymph Nodes
Page 4 Symptoms Metabolic Symptoms Urinary Symptoms Reproductive
Page 4(a) Symptoms Edema
Page 4(b) Headaches
Page 4(c) Weight Problems
Page 4(d) Prostate Problems
Page 4(e) Symptoms STDs
Page 5 Symptoms Respiratory Symptoms Sleep Symptoms Cardiovascular Symptoms Immune System Symptoms Skin General
Page 5(a) Breathing Difficulty
Page 5(b) Chest Discomfort
Page 5(c) Sleep Problems
Page 5(d) Heart Problems
Page 5(e) Anemia
Page 5(f) Symptoms Cancers Additional Cancer Questions
Page 6 Symptoms Skin Conditions Symptoms Hair Symptoms Nails Lifestyle And Exercise Diet
Page 6(a) Symptoms Nipples
Page 6(b) Symptoms Nail Abnormalities
Page 7 Food Preferences Liquid Intake Environmental Exposure Symptoms Aging Supplements And Medications
Page 7(a) Vegan Diet
Page 7(b) Alcohol
Page 7(c) Coffee And Tea
Page 7(d) Soft Drinks
Page 7(e) Tobacco Use
Page 7(f) Hazardous Substances
Page 7(g) Allergic And Adverse Reactions
Page 7(h) Reaction To Cold Damp Weather
Page 7(i) Nutritional Supplements
Page 7(j) Antacid Use
Page 7(k) Prescription Antibiotic Use
Page 7(l) Psychotropic Drug Use
Page 7(m) Hormone Use
Page 7(n) Natural Progesterone Use
Page 7(o) Laxative Use
Page 7(p) Pain Medication
Page 7(q) Anti-inflammatory Use
Page 7(r) Recreational Drugs
Page 7(s) Miscellaneous Medications
Page 8 Medical Procedures Common Lab Values Family History Childhood
Page 8(a) Past Surgeries
Page 8(b) Lab Values Cells Lab Values Chemistries Lab Values Hormones Lab Values Nutrients Lab Values Scans Other Diagnostic Tests
Page 8(c) Family History
Page 9 Contact Details Height, Weight Further Information, Comments
Last modified: Jun 29, 2024
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