Ama Questionnaire
Answer the following questions with the most appropriate response (1 = Never; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Always)
Name
First Name
Last Name
I tend to feel blocked in my body, such as head or sinus congestion, constipation, a general lack of mental clarity or other.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I catch a cold (or similar conditions) several times a year.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
When I wake up in the morning I feel foggy. It takes me awhile to really feel awake.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I feel the need to cough.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I don't have any appetite or taste for food.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I feel tired and even exhausted, both physically and mentally.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I feel unmotivated and lazy for no reason. I have the capacity to work but no inclination.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I tend to get indigestion.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I physically feel week for no apparent reason.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
I feel the need to spit.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
My body has a feeling of heaviness.
1
2
3
4
5
Never
Always
1 is Never, 5 is Always
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