PrecisionBio Ahead MAP Questionnaire

PrecisionBio Ahead MAP Questionnaire

PrecisionBio is a regenerative medicine clinic that utilizes the PrecisionBio Ahead Map Questionnaire health assessment platform to evaluate a wide range of symptoms and health concerns. Patients rate issues such as fatigue, muscle weakness, and more on a scale from 1 to 10, enabling the development of personalized, regenerative treatment plans based on their individual health profiles.
Full Name

First NameLast Name
E-mail Address
example@example.com
Contact Number
Format: (000) 000-0000.
Date of Birth

DayMonthYear
Address

Street Address

Street Address Line 2

CityCounty

Post Code
How often do you experience the following issues? Please use the slide from 1-10 to rate your symptoms (1 = minimum, 10 = maximum)
Waking up exhausted/tired
Waking up lightheaded
Difficulty arising from bed in the morning
Difficulty in handling stressful situation
Having prolonged periods of stress
Muscle weakness
Craving foods high in salt
Burst of energy
Depression, sadness, feeling down
Unexplained weight loss
Loss of energy (feeling fatigue) in the late afternoon
Loss of sex (the need to chase)
Poor work performance
Regular bedtime is missed (late at night)
Lack of energy to exercise
Aching or hurting muscles
Pain under the right side of the rib cage
Regurgitation with bitter tasting fluid
Abdominal pain with deep breathing
Belching or Burping
Excessive gas (flatulence) and/or bloating
Alternating color of stool from clay colored to normal brown
General feeling of poor health
Unable to concentrate (problem focusing)
Excessive bruising anywhere on the body
Feeling of extreme dryness
Reddened skin, especially palms
Dark urine with diminished flow
Itchy skin, worse at night
Excessive sweating in lower extremities
Fatty foods causing indigestion
Yellowish cast to skin or eyes
Shooting pain in the right upper abdomen after eating fatty foods
Type your Answer
Radiating dull pain in the right or left upper back after eating fatty foods
Low grade chronic fever
Heartburn/ Indigestion
Gas (flatulence) immediately following a meal
Loss of appetite, loss of hunger
Difficulty swallowing food
History of Anemia, unresponsive to Iron
Stomach discomfort after eating any specific type of food
Spoon shaped nails
Partial loss of taste or smell
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