Female Questionnaire
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OUR SYSTEM DOES NOT RECOGNIZE YOU

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PERSONAL BACKGROUND

Starting with the basics, we will explore all of your symptoms as we continue.

Q1

When were you last examined by a doctor? Include visits for specific health problems, health checkups, emergency room visits, or hospital stays.
  • Don't know
  • More than 5 years ago
  • 2 to 5 years ago
  • 1-2 years ago
  • Within the past year*
* more questions will be asked later

Q2

What is your ethnic background? (Various conditions affect certain groups more than others)
  • Other / mixed / don't know
  • Of African descent
  • Asian / Pacific Islander
  • Caucasian (white)
  • Latin / Hispanic

Q3

Have you traveled to the tropics within the past 5 years?
  • Don't know
  • No
  • I live in the tropics
  • Yes*
* more questions will be asked later

Q4

Approximately how far north or south of the equator (at what latitude) do you spend most of your time? If unsure, simply skip the question or enter a note.
  • Don't know / can't work it out
  • 0-23° (The tropics)
  • 24-40° (U.S. south of Great Lakes; Australia)
  • 41-56° (Northern U.S.; Canada; Europe)
  • Over 56° (Scotland; Scandinavia; Alaska)

SYMPTOMS: GENERAL

Q5

Body coordination. How good is your control over your physical movements, for example picking up something very small or catching a ball?
  • Very poor - I'm very clumsy / drop things
  • Somewhat worse than average
  • Average / don't know
  • I have better than average dexterity
  • Excellent - Very accurate control of my movements

Q6

Do you ever feel dizzy / faint / lightheaded when standing up or sitting up suddenly?
  • Don't know
  • Never / very rarely
  • Occasionally - several times per year
  • Often - several times per month
  • Always or almost always

Q7

Do you ever feel dizzy or faint when you are not standing up or sitting up suddenly?
  • Don't know
  • Never / very rarely
  • Occasionally - several times per year
  • Often - several times per month
  • Always or almost always

Q8

Do you ever experience vertigo (a sensation of you or your surroundings spinning)?
  • Don't know
  • Never
  • Occasionally
  • Regularly - several times per month
  • Frequently - daily or almost daily

Q9

Do you have a good sense of humor?
  • No, very little / none
  • Usually not
  • I'd say I'm about average / don't know
  • Yes, better than average
  • Yes, over the top

Q10

Chronic inflammation. Have you been suffering from inflammation (pain, redness, warmth, swelling) that lasts for weeks or more, or keeps coming back?
  • No / don't know
  • Minor, for one condition
  • Minor, for more than one condition
  • Major, for one condition
  • Major, for more than one condition

Q11

How easy do you find it to relax?
  • Very difficult
  • Mildly difficult
  • Average / don't know
  • Fairly easy
  • I am very relaxed by nature

Q12

Do you have a sensation of general weakness?
  • No / don't know
  • Occasional slight weakness but usually I'm fine
  • Frequent slight / occasional moderate weakness
  • Frequent moderate / occasional severe weakness
  • Severe weakness (almost) always, I can't function

Q13

What best describes your physical movements?
  • Slow / heavy
  • Average / don't know
  • Quick / efficient / light

Q14

How often do you have hiccups?
  • Rarely / 'average' / Don't know
  • Never
  • Regular minor episodes lasting several minutes
  • Regular major episodes lasting an hour or more
  • Current problem that won't stop

Q15

Have you had a problem with fatigue or becoming too easily exhausted?
  • Don't know
  • No, never
  • Yes, in the past only
  • Yes, it is a current or ongoing problem*
* more questions will be asked later

FOOD, EATING, DIETING

Q16

Do you regularly delay or skip meals?
  • My eating habits change a lot / don't know
  • No, I usually eat at least 3 meals a day
  • Yes, but I snack regularly
  • Yes, I tend to eat about twice a day, few snacks
  • Yes, I tend to eat only about once a day (or less)

Q17

How strong is your appetite (desire to eat) generally?
  • Very weak - I eat infrequently and small amounts
  • Weak
  • Average / don't know
  • Strong
  • Very strong - I rarely miss an opportunity to eat

Q18

Have you been on any weight-loss diets within the past 5 years? Weight loss surgery (bariatric surgery) will be covered later in the questionnaire.
  • No / don't know / weight loss surgery only
  • Yes*
* more questions will be asked later

Q19

Do you have any other eating-related issues? For example, loss of appetite, difficulty swallowing, eating at night, Anorexia, Bulimia, etc.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

Q20

What amount of refined sugar consumption, if any, produces a noticeable decline in your health?
  • Don't know
  • Even the smallest amount causes problems
  • Only small amounts are tolerated
  • Moderate amounts are tolerated well
  • I can tolerate regular/large amounts

SYMPTOMS: MUSCULAR

Q21

What best describes your build in terms of overall muscle and body fat composition?
  • I am very skinny with little body fat or muscle
  • I am lean / underweight with some muscle and fat
  • I am about 'normal' in terms of fat and muscle
  • I am overweight due to excess body fat
  • Very muscular with little body fat / bodybuilder

Q22

Compared to others your age, sex and size, how is your muscular strength?
  • Very poor
  • Poor
  • Average / don't know
  • Great
  • Very great

Q23

Has your muscle tone been declining? Low tone muscles are soft, loose and allow great range of motion; high tone muscles are tight, rigid and allow less motion at the joints.
  • Don't know / I have always had soft/loose muscles
  • No, my muscles are still normal or high tone
  • Yes, my muscles are now a little softer and looser
  • Yes, my muscles are now very soft and loose

Q24

How quick would you say is your reaction time / reflex? An example would be how fast your foot hits the brake when you see the car in front brake.
  • Very slow/poor
  • Slow/poor
  • Average / don't know
  • Fast/good
  • Very fast/good

Q25

Have you had problems with any muscles, large or small? Include diseases such as Parkinson's, or specific signs/symptoms like muscle loss, weakness, pain, spasms, twitching, cramping, tremors, tightness, rigidity, soreness, etc., but not seizure activity.
  • Don't know
  • No
  • Yes, I have muscular problems or disease*
* more questions will be asked later

SYMPTOMS: SKELETAL

Q26

Are you shorter than you used to be?
  • No / don't know
  • Yes, an inch (2.5cm) or less
  • Yes, more than one inch (2.5cm)

Q27

How good is your posture? Poor posture means shoulders and head hunched forward, with back curved. Good posture means shoulders pulled back slightly, ears over shoulders, level chin, straight mid back, and shoulders, hips and ankles in line when standing.
  • Don't know
  • Always poor - I slouch all the time
  • Usually poor
  • Not too bad but could be improved
  • Usually/always good - I try to maintain my posture

Q28

What is the length of your fingers and toes?
  • Very short / stubby
  • Short / stubby
  • Average / don't know
  • Long / slender
  • Very long / slender

Q29

Have you ever broken any bones?
  • No / don't know
  • Once
  • Twice
  • Three times
  • Four times or more

Q30

Do you have a history of stress fractures? Symptoms include pain, tenderness and/or swelling at the site of injury, and pain that is worse during exercise but decreases or disappears with rest.
  • No / don't know
  • Probably, but it was never confirmed
  • Yes, one
  • Yes, several

Q31

Do you suffer from diffuse bone pain? In other words, vague bone pain that is impossible to pinpoint exactly? Do not include pain that is due to a known injury.
  • Pain is due to an injury / don't know
  • No
  • Slight, not always noticeable
  • Significant or always noticeable
  • Severe

Q32

Morning stiffness. Do your joints feel stiff or painful when you wake up in the morning?
  • Don't know
  • No / less than once a year
  • Yes, but rarely - less than once a month
  • Yes, it started less than 6 weeks ago
  • Yes, it started over 6 weeks ago*
* more questions will be asked later

Q33

Spine and back problems. Have you experienced any problems with your neck, upper back, or lower back? Examples include slipped disc, injury, other pain, stiffness other than morning stiffness, deformity or disability.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

Q34

Joint problems. Have you experienced any problems with your jaw, shoulders, elbows, wrists, fingers, hips, knees, ankles or toes? Examples include arthritis, other pain, injury, dislocation, deformity or disability.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

Q35

Have you had any problems with your limbs (arms, hands, legs, feet)? Examples include pain, reduced function or disability. Do not include joint problems, which are covered elsewhere.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: NERVOUS

Q36

Do you suffer from Bell's Palsy (facial muscle droop - one-sided facial paralysis)?
  • No / don't know
  • I think I might have it
  • Yes, slightly
  • Yes, significantly
  • Yes, I am severely affected

Q37

Aside from your face, have you experienced paralysis anywhere else in your body?
  • No / don't know
  • Yes, it was caused by physical injury
  • Yes, in one part of my body, not from injury
  • Yes, two or more parts of my body, not from injury

Q38

When at rest, do you ever experience 'odd feelings' in your legs, and feel the need to move them in order to stop those feelings? This is known as Restless Legs Syndrome.
  • Don't know
  • No
  • Yes, slightly / occasionally
  • Yes, definitely / often

Q39

What is your level of pain tolerance generally?
  • Very poor pain tolerance
  • Poor pain tolerance
  • Average / don't know
  • High pain tolerance
  • Very high pain tolerance

Q40

Do you ever injure yourself without noticing (feeling) it? An example would be cutting yourself with a knife and only finding out when someone points out the blood.
  • Don't know
  • No - I always feel injuries
  • Sometimes
  • All or most of the time

Q41

Anywhere on your body, do you have any abnormal skin sensations or lack of sensation? This includes reduction in the sense of touch, pain, burning, tingling, pins and needles, vibrations, numbness, etc.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: LIVER / GALLBLADDER

Q42

Have you had any problems with your gallbladder that you know of?
  • Don't know
  • No
  • Yes / possibly*
* more questions will be asked later

Q43

Have you had any problems with your liver? For example, Cirrhosis, Hepatitis, enlarged liver.
  • Don't know
  • No
  • Yes / possibly*
* more questions will be asked later

Q44

Have liver/gallbladder cleanses helped you?
  • Never tried one / don't know
  • No, there was no benefit
  • There was some benefit
  • Moderate benefit
  • Significant benefit

SYMPTOMS: BOWEL MOVEMENTS

If you use laxatives, try to answer according to how things would be without them.

Q45

How offensive do your stools usually smell? This is difficult to quantify, but a strong smell despite brief exposure to the air, or comments by others, are good indicators!
  • Don't know
  • Never / rarely offensive
  • Occasionally offensive
  • Often offensive
  • Always offensive

Q46

Approximately how often do you suffer from diarrhea?
  • Very rarely / it is not a problem / don't know
  • Occasionally - a few times a year
  • Regularly - at least once a month
  • Often - at least once a week
  • Frequently - after most or all meals

Q47

If you suffer significantly from diarrhea (at least once per week), for how long has this been a problem?
  • It is not a problem / don't know
  • It started within the last week
  • It started within the last month
  • I've had it for 1 to 3 months
  • I've had it for over 3 months

Q48

Are your bowel movements/stools at all unusual? For example, under one a day, over two a day, frequent urges, variation in consistency/pattern, sticky, oily, black, pale, unusual color, or containing mucus, red blood, or undigested fat/food.
  • Don't know
  • No, they are well-formed, regular, easy to pass
  • Yes*
* more questions will be asked later