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Inflammatory Assessment

Understand your individual inflammation level

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Question 1 of 9

Hello, 

We have designed this brief questionnaire to get an idea of what your current level of inflammation is within your body.

What is your full name?

Question 2 of 9

What is your email address?

Question 3 of 9

What is the best phone number to reach you at if needed?

Question 4 of 9

How often do you feel bloated, gassy and/or have stomach distention or abdominal pain after eating or in-between meals?

A

Never

B

Rarely

C

Sometimes

D

Often

E

Always

Question 5 of 9

How often do you experience headaches or migraines?

A

Never

B

Rarely

C

Sometimes

D

Often

E

Always

Question 6 of 9

How often do you find yourself having unexplained mood swings, lack of motivation, depression, anxiety or worry?

A

Never

B

Rarely

C

Sometimes

D

Often

E

Always

Question 7 of 9

Do you find yourself getting sick more frequently?  Also, when you are sick do the symptoms appear more severe than in the past, and do you experience difficulties with recovery?

A

Never

B

Rarely

C

Sometimes

D

Often

E

Always

Question 8 of 9

How often do you have difficulty falling asleep, staying asleep or waking in the middle of the night and can't fall back to sleep, or feel rested after a night of sleep?

A

Never

B

Rarely

C

Sometimes

D

Often

E

Always

Question 9 of 9

Females: 

Do you have heavy or irregular periods, severe cramping, extreme breast tenderness, facial hair, acne or loss of libido?

 

Males:

Do you have hair loss, erectile dysfunction, decreased libido, breast formation?

A

Never

B

Rarely

C

Sometimes

D

Often

E

Always

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