This questionnaire is designed to help you determine if you may have symptoms of a adrenal fatigue. Rate each question from 0-5 with “0″ representing on symptoms at all and “5″ being severe symptoms.
Do you feel FATIGUE ALL THE TIME
Do you have DIFFICULTIES GETTING UP IN THE MORNING
Do you CRAVE SALT
Do you CRAVE SUGAR
Are you experiencing DIMINISH SEX DRIVE
Do you feel DISORIENTED
Do you have to WORK HARDER BUT ACCOMPLISHING LESS
Do you experience UNEXPLAINED SADNESS
Do you experience FORGETFULNESS more frequently
Did you become more IRRITABLE, SHORT-TEMPERED
Are you Feeling more DISAPPOINTED WITH PEOPLE AROUND YOU
Do you suffer from HEADACHES
Do you experience HOT FLASHES
Dos your BLOOD PRESSURE INCREASED
Do you experience HAIR GROWTH over BODY OR FACE (FEMALE)
Do you notice MASCULINE TENDENCIES (FEMALE)
Do you experience WEAKNESS AND/OR DIZZINESS
Do you have LOW BLOOD PRESSURE
Are your NAILS WEAK AND/OR RIDGED
Do you have TENDENCY TOWARD HIVES
Do you have ARTHRITIC TENDENCIES
Dos your PERSPIRATION INCREASE
Do you suffer from POOR CIRCULATION
Do you have SWOLLEN ANKLES
Do you have BROWN SPOTS OR BRONZING OF SKIN
Do you have ALLERGIES or TENDENCY TO ASTHMA
Do you Experience WEAKNESS AFTER COLDS OR INFLUENZA
Do you suffer from MUSCULAR AND NERVOUS EXHAUSTION
TOTAL:
Legend: 20-40 you may have mild adrenal stress; 41-70 you man have moderate adrenal fatigue; 70 and up you may have significant adrenal fatigue.
If you are concern about your symptoms and are ready to address them personalize, nutritional evaluation and programs customized to your health needs are available. To schedule your appointment, contact our office at (214) 783-8721or e-mail: info&womananew.com
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