Fields marked with an * are required The 3-step checklist 30,000 doctors use to pinpoint and successfully treat people with headaches, digestive disorders and frustrating overweight. Which symptom are you experiencing? * HeadachesDigestive DisordersFrustrating Overweight Detailed set of symptom questions SYMPTOM POINT SCALE: Use the point scale to rate your symptoms based on how you’ve been feeling over the past 30 days. 0 = never or almost never have the symptom 1 = occasionally have it, effect is not severe 2 = occasionally have it, effect is severe 3 = frequently have it, effect is not severe 4 = frequently have it, effect is severe 0 1 2 3 4 Dizziness 01234 Faintness 01234 Headaches 01234 Insomnia 01234 Lightheadedness 01234 Aches in muscles 01234 Arthritis 01234 Feeling of weakness 01234 Limited movement 01234 Pain in joints 01234 Stiffness 01234 Detailed set of symptom questions SYMPTOM POINT SCALE: Use the point scale to rate your symptoms based on how you’ve been feeling over the past 30 days. 0 = never or almost never have the symptom 1 = occasionally have it, effect is not severe 2 = occasionally have it, effect is severe 3 = frequently have it, effect is not severe 4 = frequently have it, effect is severe 0 1 2 3 4 Belching 01234 Bloated feeling 01234 Constipation 01234 Diarrhea 01234 Nausea 01234 Passing gas 01234 Stomach pains 01234 Vomiting 01234 Detailed set of symptom questions SYMPTOM POINT SCALE: Use the point scale to rate your symptoms based on how you’ve been feeling over the past 30 days. 0 = never or almost never have the symptom 1 = occasionally have it, effect is not severe 2 = occasionally have it, effect is severe 3 = frequently have it, effect is not severe 4 = frequently have it, effect is severe 0 1 2 3 4 Binge eating 01234 Compulsive eating 01234 Cravings 01234 Excessive weight 01234 Underweight 01234 Water retention 01234 Other Symptoms SYMPTOM POINT SCALE: Use the point scale to rate your symptoms based on how you’ve been feeling over the past 30 days. 0 = never or almost never have the symptom 1 = occasionally have it, effect is not severe 2 = occasionally have it, effect is severe 3 = frequently have it, effect is not severe 4 = frequently have it, effect is severe EARS 0 1 2 3 4 Drainage from ear 01234 Ear aches 01234 Ear infections 01234 Hearing loss 01234 Itchy ears 01234 Ringing in ears 01234 EMOTIONS 0 1 2 3 4 Aggressiveness 01234 Anxiety/fear 01234 Depression 01234 Irritability/anger 01234 Mood swings 01234 Nervousness 01234 ENERGY & ACTIVITY 0 1 2 3 4 Apathy 01234 Fatigue 01234 Hyperactivity 01234 Lethargy 01234 Restlessness 01234 Other Symptoms EYES 0 1 2 3 4 Blurred vision 01234 Dark circles 01234 Itchy eyes 01234 Sticky eyelids 01234 Swollen eyelids 01234 Watery eyes 01234 LUNGS 0 1 2 3 4 Asthma/bronchitis 01234 Chest Congestion 01234 Difficulty Breathing 01234 Shortness of Breath 01234 Wheezing 01234 MOUTH & THROAT 0 1 2 3 4 Canker sores 01234 Gagging 01234 Often clear throat 01234 Sore throat 01234 Swollen tongue/lips/gums 01234 Other Symptoms NOSE 0 1 2 3 4 Excessive mucous 01234 Hay fever 01234 Sinus problems 01234 Sneezing attacks 01234 Stuffy nose 01234 SKIN 0 1 2 3 4 Acne 01234 Dermatitis 01234 Eczema 01234 Excessive sweating 01234 Flushing/hot flashes 01234 Hair loss 01234 Hives/rashes 01234 Itching 01234 Other Symptoms MIND 0 1 2 3 4 Confusion 01234 Learning disabilities 01234 Poor concentration 01234 Poor memory 01234 Stuttering/stammering 01234 OTHER 0 1 2 3 4 Anaphylactic reactions 01234 Chest pains 01234 Frequent illness 01234 Genital itch 01234 Irregular heartbeat 01234 Rapid heartbeat 01234 We have a personalized food allergy analysis for you, including a Free Consultation with a client support expert on your #1 problem. Please, tell us where to send your results: First Name * Email *
