Please rate the following from 0 to 5, with 0 being no problem and 5 being a severe problem.
Difficulty getting up in the morning 0 1 2 3 4 5
Continuing fatigue, not relieved by sleep and rest 0 1 2 3 4 5
Lethargy, lack of energy to do normal daily activities 0 1 2 3 4 5
Sugar cravings 0 1 2 3 4 5
Salt cravings 0 1 2 3 4 5
Allergies 0 1 2 3 4 5
Digestion problems 0 1 2 3 4 5
Increased effort needed for everyday tasks 0 1 2 3 4 5
Decreased interest in sex 0 1 2 3 4 5
Decreased ability to handle stress 0 1 2 3 4 5
Increased time needed to recover from illness, injury, or traumas 0 1 2 3 4 5
Light-headed or dizzy when standing up quickly 0 1 2 3 4 5
Low mood 0 1 2 3 4 5
Less enjoyment or happiness with life 0 1 2 3 4 5
Increased PMS 0 1 2 3 4 5
Symptoms worsen if meals are skipped or inadequate 0 1 2 3 4 5
Thoughts are less focused, brain fog 0 1 2 3 4 5
Memory is poorer 0 1 2 3 4 5
Decreased tolerance for stress, noise, disorder 0 1 2 3 4 5
Don't really wake up until after 10:00 a.m. 0 1 2 3 4 5
Afternoon low between 3:00 p.m. and 4:00 p.m. 0 1 2 3 4 5
Feel better after supper 0 1 2 3 4 5
Get a "second wind" in the evening, and stay up late 0 1 2 3 4 5
Decreased ability to get things done - less productive 0 1 2 3 4 5
Have to keep moving - if I stop, I get tired 0 1 2 3 4 5
Feeling overwhelmed by all that needs to be done 0 1 2 3 4 5
It takes all my energy to do what I have to. There's none left over for anything or anyone else 0 1 2 3 4 5
Fatigue 0 1 2 3 4 5
Muscle aches and pains 0 1 2 3 4 5
Joint Pains 0 1 2 3 4 5
Fibromyalgia 0 1 2 3 4 5
Feelings of weakness 0 1 2 3 4 5
Concentration difficulties 0 1 2 3 4 5
Mental sluggishness 0 1 2 3 4 5
Depression 0 1 2 3 4 5
Cold hands and feet 0 1 2 3 4 5
Sensitivity to cold 0 1 2 3 4 5
Tendency towards constipation 0 1 2 3 4 5
Weight gain 0 1 2 3 4 5
Low blood sugar/hypoglycemia 0 1 2 3 4 5
Menstrual problems 0 1 2 3 4 5
Heavy bleeding during menses 0 1 2 3 4 5
Repeated colds and flu 0 1 2 3 4 5
Skin problems (itching, eczema, psoriasis, acne, or coarse, dry skin 0 1 2 3 4 5
Do not perspire easily 0 1 2 3 4 5
Hoarse voice 0 1 2 3 4 5
Feeling of fullness in neck 0 1 2 3 4 5
Swelling of the eyelids 0 1 2 3 4 5
Hair loss 0 1 2 3 4 5
Dry, coarse hair 0 1 2 3 4 5
Loss of outer 1/3 of eyebrows 0 1 2 3 4 5
Have about as many mental and emotional symptoms as physical symptoms 0 1 2 3 4 5