Circle any symptoms that pertain to you:
Headaches Nasal congestion Suicidal thoughts Lymph node swelling
Vision loss/changes Trouble falling asleep Nerve pain/tingling
Breat lumps/masses Hearing loss/changes Trouble staying asleep
Arthritis/joint pain Constipation Sinus pressure Snoring Rash/eczema
Diarrhea Post nasal drip/throat closing Mouth breathing Hives
Bloating/gas Cough Heart palpiations Difficulty in moving extremities
Abdominal pain Chest pain Depression Swelling Nausea/vomiting
Shortness of breath Anxiety Neck pain Difficulty in urination
Menstrual irregularities Hair loss Cold/heat intolerance Thyroid problems
Difficulty breathing Frequent illnesses Food allergies Food sensitivities