Directions: In order to provide you with a comprehensive health assessment and plan, we need you to carefully compete the following questionnaire. Please select the answer that most closely matches the severity and/or frequency of your symptoms: 0 = None or Never; 1 = Mild or Occasional; 2 = Moderate or Frequent; 3 = Severe or Most of the Time.
Mental & Emotional Health Score:
Energy & Metabolism Score:
Skin & Hair Score:
Lung/Respiratory System Score:
Immune Function Score:
Gastrointestinal Tract Score:
Urinary Tract Score:
Men Only Score:
Women Only => Premenstrual Symptoms (PMS) Score:
Women Only => Menstrual Symptoms Score:
Women only => Other Female Symptoms Score:
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