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  • Medical Symptom Questionnaire

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  • Please select an appropriate response for every symptoms/condition.
    This questionnaire is assessing symptoms experienced over the past 2 weeks (14 days).

    0 = None/Absent
    1 = Minimal Symptoms or Infrequent
    2 = Mild Severity of a Few Days
    3 = Moderate Severity or Most Days
    4 = Severe Symptoms or Daily

  • GI: Absorption and Assimilation

  • Immune

  • Structural Integrity

  • Energy

  • Communication

  • Transport

  • Biotransformation & Elimination

  • Should be Empty: