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Rate each of the following symptoms based on your typical health profile for the past 30 days:

DIGESTIVE TRACT

Nausea or vomiting
Diarrhea
Constipation
Bloated feeling
Belching or passing gas
Heartburn

EARS

Itchy ears
Ear aches, ear infections
Drainage from ears
Ringing in ears, hearing loss

EMOTIONS

Mood swings
Anxiety, fear or nervousness
Anger, irritability or aggressivenesss
Depression

ENERGY & ACTIVITY

Fatigue, sluggishness
Apathy, lethargy
Hyperactivity
Restlessness

EYES

Watery or itchy eyes
Swollen, reddened or sticky eyelids
Bags or dark circles under eyes
Blurred or tunnel vision

(does not include near or far sightedness)

HEAD

Headaches
Faintness
Dizziness
Insomnia

HEART

Irregular or skipped heartbeat
Rapid or pounding heartbeat
Chest pain

JOINTS OR MUSCLES

Pains or aches in joints
Arthritis
Stiffness or limitation of movement
Pains or aches in muscles
Feeling of weakness or tiredness

LUNGS

Chest congestion
Asthma, bronchitis
Shortness of breath
Difficulty breathing

MIND

Poor memory
Confusion, poor comprehension
Difficulty in making decisions
Stuttering or stammering
Slurred speech
Learning disabilities

MOUTH/THROAT

Chronic coughing
Gagging frequently, need to clear throat
Sore throat, hoarseness, loss of voice
Swollen or discolored tongue, gums, lips
Canker sores

NOSE

Stuffy Nose
Sinus problems
Hay fever
Sneezing attacks
Excessive mucus formation

SKIN

Acne
Hives, rashes or dry skin
Hair loss
Flushing or hot flashes
Excessive sweating

WEIGHT

Binge eating
Craving certain foods
Excessive weight
Compulsive eating
Water retention
Underweight

OTHER

Frequent illness
Frequent or urgent urination
Genital itch or discharge

OTHER INFORMATION

Any other information or comments

CONTACT INFORMATION

Name *
Email Address *

Alternative Healthcare

Alternative Healthcare is designed to offer the best and the most up to date information about alternative health care.

Alternative Healthcare offers better ways than regular medicine - allopathic medicine - for maintaining a healthy body, and a safer and more effective way to treat illness, especially chronic illness