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YesNoVegetarian
Poor AppetitePoor SleepFatigueFeversChillsNight SweatsSweat EasilyTremorsCravingsLocalized WeaknessPoor BalanceChange in AppetiteBleed/Bruise EasilyWeight Loss/GainPeculiar Tastes/SmellsDental/Gum ProblemsMuscle Weakness/FatigueStrong Thirst (Cold/Hot Drinks)
RashesUlcerationsHives/Allergic DermatitisItchingEczema/PsoriasisDandruffLoss of HairMolesSkin DiscolorationsAcneChange in Skin/Hair TextureFace Flushing
DizzinessDifficulty SwallowingMigrainesEye GlassesEye StrainEye PainPoor VisionNight BlindnessColor BlindnessCataractsBlurred VisionEarachesRinging in EarsPoor HearingSpots in Front of EyesSinus ProblemsNosebleedsRecurrent Sore Throats/ColdsTeeth GrindingFacial PainHeadachesDental ProblemsJaw Clicks/LocksSores on Lips/Tongue
Chest PainIrregular HeartbeatPalpitations at RestFaintingCold Hands/FeetSwelling of Hands/FeetBlood ClotsPhlebitisShortness of BreathVaricose/Spider VeinsPressure in Chest
CoughCoughing BloodAsthmaBronchitisPneumoniaPain with Deep InhalationTight Sensation in ChestWheezingDifficult to Inhale/ExhaleProduction of PhlegmOther Problems
NauseaVomitingDiarrheaConstipationGasBelchingBlack StoolsBlood in StoolsIndigestionBad BreathRectal PainHemorrhoidsBloating/EdemaChronic Use of LaxativesLoose StoolsAbdominal Pain/CrampsChanges in AppetiteAcid RefluxHerniaOther Problems
Pain on UrinationFrequent UrinationBlood in UrineUrgent UrinationUnable to Hold UrineKidney StonesScanty FlowCopious FlowImpotenceSores on GenitalsUrinary Tract InfectionsBurning UrinationPremature EjaculationDecreased LibidoProstatitisDribbling after Urination
YesNo
Ovarian CystsBreast LumpsVaginal SoresFibrocystic Breast TissueVaginal DischargeFibroid TumorsVaginal DrynessInfertilityDifficult IntercourseEndometriosisPainful MensesIrregular Menstruation
Neck PainShoulder PainHand/Wrist PainCarpal TunnelKnee PainSprains/StrainsSciaticaFoot/Ankle PainHip PainMuscle PainMuscle WeaknessTendonitisBursitisRotator CuffBack Pain - LowerBack Pain - MiddleBack Pain - Upper
SeizuresLoss of BalanceVertigo/DizzinessAreas of NumbnessLack of CoordinationPoor MemoryConcussionDepressionAnxiety/Panic AttacksBad Temper/IrritableEasily Susceptible to StressSeasonal Affective Disorder
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