Rate each of the following symptoms to the best of your ability based upon your typical health profile over the last year. If you cannot answer a question, simply leave it blank.

Enter the numeric value, based on the Point Scale above, into the empty field under each line item.

Begin the Quiz....

Unexplained weight gain, or difficulty losing weight regardless of diet or exercise (Rate from 0-4 - see above scale) *

Frequent illness, prolonged illness or sick days, or often feeling like you're getting a cold or flu (Rate from 0-4 - see above scale) *

Fluctuating constipation and diarrhea, or stomach pains for no obvious reason (Rate from 0-4 - see above scale) *

Anxiety, mood swings, irritability, anger or depression (Rate from 0-4 - see above scale) *

Insomnia (can’t get to sleep or return to sleep), excessive sweating at night, or non restful sleep (Rate from 0-4 - see above scale) *

Sound in ears (ringing or hearing your heart beat), sound sensitivity, or light sensitivity (Rate from 0-4 - see above scale) *

Indecisiveness, brain fog, trouble processing new information, short term memory loss, or dizziness (Rate from 0-4 - see above scale) *

Bad breath, bleeding gums, or canker sores (Rate from 0-4 - see above scale) *

Hair falls out (not normal male pattern baldness), dry skin, or rashes (Rate from 0-4 - see above scale) *

Chronic fatigue or weakness, low energy, or afternoon slumps (Rate from 0-4 - see above scale) *

Chronic sinus congestion, dry cough, twitching eyes, or headaches (Rate from 0-4 - see above scale) *

Joint pain (not necessarily true arthritis, can move from joint to joint), morning stiffness, or frequent muscle aches or cramps (not exercise related) (Rate from 0-4 - see above scale) *

Please enter your Name and Email address below, so that I can send you your quiz results:

First Name *

Email *