Track how your symptoms have changed since your last visit.
Use the same email you used on your initial survey so we can compare your progress.
1 = Occasionally, mild · 2 = Frequently, mild3 = Occasionally, severe · 4 = Frequently, severe
Fatigue (sluggish, tired)
Hyperactive (nervous energy)
Restless (can't relax/sit still)
Daytime sleepiness
Insomnia at night
Malaise (feeling lousy)
Seizures
Depression
Anxiety (fears, uneasiness)
Mood swings (rapid changes)
Irritability
Forgetfulness
Lack of concentration / Brain fog
Low sex drive
Headache (not migraine)
Migraine
Earache
Ear infection
Ringing in ears
Itchy ears
Discharge from ears
Sensitivity to sound
Blemishes, acne
Rashes or hives
Eczema or psoriasis
"Rosy" cheeks
Flushing
Itchy skin
Post nasal drip
Sinus pain
Runny nose
Stuffy nose
Sneezing
Sore throat
Swollen throat
Swelling/burning lips/tongue
Gagging/throat clearing
Canker sores
Difficulty swallowing
Wheezing
Chest congestion
Dry cough
Wet cough
Shortness of breath
Red or swollen eyes
Watery eyes
Itchy eyes
Dark circles or "bags"
Sensitivity to light
Aura
Increased urinary frequency
Painful urination
Bladder pain
Bedwetting
Joint pains
Stiff joints
Muscle aches
Stiff muscles
Tic nervioso
Muscle spasms
Muscle cramps
Irregular heartbeat
High blood pressure
Heartburn/reflux
Stomach pains/cramps
Intestinal pains/cramps
Constipation
Diarrhea
Bloating sensation
Gas (of any kind)
Nausea
Vomiting
Painful elimination
Fluctuating weight
Food cravings
Water retention
Binge eating or drinking
Purging (all methods)
Grand Total
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