Q400 Symptomology Analysis

Q400 Questionnaire - {$259.00}


*  - Denotes a REQUIRED entry.
Select the comments in the questionnaire below that describe your condition within the past six months ONLY.

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* First Name:  Recommended By:  
* Last Name:  Clinic Name:  
* Street Address : * Age:  
* City: * Height - Feet: * Inches:  
* State: * Weight in Pounds:  
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* E-mail address: * Sex: Male Female  

      1 Poor or weak respiration 2 (Male) Penis smaller than normal 3 Skin blemiches
      4 Depression 5 Motion sickness 6 Abnormal blood
      7 Tired eyes 8 Gums bleed 9 (Female) Breast underdeveloped
      10 Apathy 11 Weak ligaments 12 Oily chin
      13 Lower bowel gas 14 Bad breath 15 I am a vegetarian
      16 (Female) Menstrual irregular 17 (Female) Infertility 18 Twitching muscles
      19 I use tobacco 20 Noises in ears 21 Abnormal exhaustion
      22 Fatigue 23 Attitude of complaint 24 Overall weakness
      25 Bad circulation 26 Hyperactive 27 Inflamed rectum
      28 Infections of urinary tract 29 Bitter taste in mouth 30 Gall bladder disorders
      31 Abnormal diarrhea 32 I get angry easily 33 I feel apprehension
      34 Swelling of the feet 35 Lifestyle stress 36 Thin and anemic looking
      37 Skin scaling 38 Colds and sinusitis 39 Body feels cold
      40 Lip soreness 41 Earaches and infections 42 Can't gain weight
      43 Severe arthritis 44 Poor circulation in feet 45 Bronchial problems
      46 Very sedentary 47 Ruptured veins 48 Muscle cramps
      49 Eyes seem to be staring 50 Thickened saliva 51 Stiffening of muscles
      52 Irregular jog/run 53 Muscle swelling 54 General confusion of mind
      55 Hands feel hot 56 Shaking of the body 57 Night blindness
      58 (FEMALE) My sex drive is down 59 I am thin and weak 60 I have paleness under top eyelid
      61 Muscular dystrophy 62 Pain about shoulder blade(s) 63 General aches and pains
      64 Hardening of arteries 65 Skin scaling about the ears 66 Dry mouth
      67 Corners of mouth split 68 Get infections easily 69 Inside the mouth gets sores
      70 Goiter 71 Daily chores seem difficult 72 Red face like sunburn
      73 Leg pains 74 Skin eruptions 75 Gall bladder stones
      76 My blood pressure is too high 77 Soft teeth 78 I fear the dark
      79 Mucous in bowel movement 80 Abdominal bloating 81 Constantly hungry
      82 Emotional outburst 83 Dull hearing 84 Feel that I am shorter than normal
      85 Middle ear problems 86 Over acidity    
      87 Nervousness 88 Periodic vomiting    
      89 Poor posture 90 Gastro-intestinal disturbances 91 Near sighted
      92 Scratchiness feeling when eyes are closed 93 Constant urination 94 Numbness at times
      95 Stiff joints 96 Skin cyst 97 Feelings of hostility
      98 Abnormally large nose 99 I stagger when I walk 100 Weak legs
      101 Stomach ulcers 102 (FEMALE) My pubic hair is too thin 103 Overall energy is low
      104 Abdominal area is flabby 105 Daydream 106 Spasms
      107 (FEMALE) Menstrual cycle stopped 108 Medically diagnosed low blood sugar 109 Inflammation
      110 Puffy eyelids 111 Skin is extra sensitive 112 Uncomfortable aches in my legs
      113 (FEMALE) Vaginal itch 114 Regular headaches 115 Skin on forehead scaly
      116 Tongue has a white coating 117 Itchiness inside ears 118 Brownish spots on skin
      119 Aging too fast 120 Work is a drudgery 121 Easy weight gain
      122 Lack of smell 123 Very moody 124 Legs feel stiff
      125 Over exposure to X-ray or radiation 126 Hard milky white tissure areas 127 A finger or fingers feel numb
      128 Pain during urination 129 I'm stiff from degenerative disease 130 (FEMALE) Imbalance of hormones
      131 Lazy mentally unintentionally 132 Excess tension 133 Excess height
      134 Palpitations 135 Calluses on hands 136 Constant yawning or sighing
      137 (MALE) Sexual difficulties 138 Scaling skin or roughness about arms and/or legs 139 (FEMALE) Lack of reproduction when young
      140 Poor teeth enamel 141 Mentally dull - slow mind 142 Low blood pressure
      143 Muscle cramps 144 Get sick easily 145 Wrinkles
      146 Cramps in legs 147 Poor appetite 148 Difficulty in hearing
      149 Loss of muscle tone 150 Blood shot eyes 151 Heart problems
      152 Difficulty with speech 153 Weak voice 154 Poor endurance
      155 Skin rashes 156 Constantly fearful 157 Arteriole problems
      158 (FEMALE) Ovary swelling 159 I don't do a good job at work 160 (MALE) Prostate swelling
      161 Hands that are chapped 162 Foggy thinking 163 Greasy and oily skin
      164 Cold hands 165 Balding 166 Hoarseness caused by dry cough
      167 Cyst 168 Nauseous at times 169 Galloping heart
      170 (FEMALE) Conception has been difficult 171 Tongue is sore and reddish in color 172 Boils
      173 (MALE) Shrinking testicles 174 Shooting pains 175 Canker sores about the mouth
      176 Arms that tremble 177 Night confusion 178 My face gets puffy and swollen
      179 Undigested food 180 Forgetfulness 181 Sagging muscles
      182 Upper respiratory problems 183 Restlessness 184 Pale face
      185 Forehead perspires easily 186 Dry eyes 187 Obese
      188 Sensitive to noise 189 Diabetes 190 Emotions are unstable
      191 (FEMALE) Lactating mother 192 (MALE) Low sperm count 193 Mental exhaustion
      194 Excess muscle tension 195 Suspicious nature 196 Periodic itching spells
      197 Eyelid inflammation 198 Fatty muscles 199 Brain damage
      200 Hair lacks sheen 201 Lazy nature 202 Abnormal body temperature
      203 Nervous exhaustion 204 Asthma 205 Weakness of muscles
      206 Deformed teeth 207 Dark urine 208 Back of hands appear sunburned
      209 Reduced visual capacity in faint light (as at night) 210 Constipation 211 Graying of hair
      212 (FEMALE) Vaginal rash 213 Tomorrow's coming is frightful 214 Anemic
      215 Bad body odor 216 Bloody discharge 217 Easily bruised
      218 Pupils of eyes stay dilated 219 (FEMALE) PMS tension 220 Excess coating on tongue
      221 Feet get cold easily 222 (MALE) Sexual indifference 223 Constantly sleepy or drowsy
      224 Unwarranted feelings of grief 225 Gum disease 226 Listless
      227 Fatigue by hot weather 228 High cholesterol in blood 229 Very nervous person
      230 Difficulties with lungs 231 Tongue painful 232 Spinal problems
      233 Consume large amounts of prepackaged food 234 Unexplained tender spots 235 Poor healing of sores
      236 Abnormal skin blemishes 237 Bowel problems 238 Night sweats
      239 Pus pockets on scalp 240 Too hot or too cold hurts teeth 241 Tendency to arthritis
      242 Infections of respiratory system 243 Unstable mentally 244 Edema of the legs
      245 Chapped lips 246 Teeth get loose 247 Lack of courage
      248 Crust on skin about the ears 249 (FEMALE) Female complaints 250 (FEMALE) Odoriferous vaginal discharge
      251 Hair loss 252 Shortness of breath 253 Shooting arm pains
      254 Constantly thirsty 255 High cholesterol 256 Burning of feet
      257 Discharge from ears 258 Low hydrochloric acid level 259 Wrist discomfort
      260 Heat strokes 261 Abnormal Blood pressure (high or low) 262 Swelling of ankles
      263 Hemorrhoids 264 Swelling of glands 265 (FEMALE) Inflamed vagina
      266 Fingers and hands seem to tingle 267 Hands feel uncomfortable 268 Cataracts
      269 Sciatica 270 Weakness of arms 271 When walking I real/totter from side to side
      272 Perception is poor 273 Anxious state 274 Itching eyeballs
      275 I drink unfiltered water 276 Constantly craving of sweets 277 Rheumatism
      278 Belching or lower gas 279 Involuntary contractions of muscles 280 Slow growth of hair
      281 Feeling of suffocation 282 Poor body development 283 Hands tremble at times
      284 Breaking of veins 285 Loss of hearing 286 Poor assimilation
      287 Use of medicinal drugs 288 Decaying teeth 289 I am taking cortisone
      290 Constantly craving salt 291 Abnormal toe nails 292 Numbness or tingling in toes
      293 Very little sunshine to the skin 294 Diagnosed angina 295 Brooding attitude
      296 Intermittant nose bleeds 297 Consume fruits - vegtables 298 Bladder difficulties
      299 (FEMALE) Menstrual cramps or discomfort 300 (FEMALE) Problems with uterus 301 Throat tightness
      302 Sties 303 Weight loss with weakness 304 (FEMALE) Indifference to sex
      305 Cancer 306 Urination difficulties 307 Senitive to light
      308 Acne 309 Pain in the abdominal area 310 Fingernail abnomalities
      311 Insomniac 312 Eyelids twitch 313 Problems with vision
      314 Body tingling 315 Painful feet 316 Crust about the nose
      317 Muscles abnomalties 318 Feel persecuted 319 Nerve disease
      320 (FEMALE) Morning sickness 321 (MALE) Small testicles 322 Abnomal heart rhythm
      323 (FEMALE) Difficult labor 324 Feeling of sluggishness 325 Body temperature less than 98 degrees
      326 Urethra or ureter inflammation 327 Stools float 328 (FEMALE) Sorness of vagina
      329 Unfounded fears 330 Jerking of legs 331 Bloody urine occasionally
      332 Psoriasis 333 Problem with drandruff 334 I live in a large city
      335 (FEMALE) Miscarriages 336 Fat deposits 337 The white of my eye appears yellow
      338 Indigestion 339 Sticky substance in the eye 340 Irritable disposition
      341 Specs before the eyes 342 Hay fever 343 Skin roughness
      344 (FEMALE) Late menstruation 345 Lack of saliva 346 Gums tender
      347 Toxemia 348 Cordination off 349 Slow reflexes
      350 Skin is dry 351 Left arm is painful 352 Phlebitis
      353 Loss of or poor manual dexterity 354 Kidney stones 355 Backwordness of manner
      356 Joyless appearance 357 Tendency to quarrel 358 Nervous agitation
      359 Inflamation of the bladder 360 Deafness 361 Bed wetting
      362 Sick and tired feeling 363 Unexplained dizziness 364 Arm cramps
      365 Back aches 366 Weak or damaged kidneys 367 Strain on eyes when focusing
      368 Difficult breathing - bluish skin 369 Walking is difficult 370 Heart beat is too rapid
      371 Legs feel like pins poking them 372 Hemorrhages or cuts bleeding excessively 373 Mental illness - insanity
      374 Unwillingness - Uncooperative 375 Lack of unination at times 376 Heart feels like it is pounding
      377 (FEMALE) Premature children 378 Pernicious anemia 379 Disoriented
      380 Stools are light colored 381 Bowel inflammation 382 (FEMALE) Menstrual is slow
      383 (FEMALE) I take oral contraceptives 384 Muscles are painful 385 I do not feel good after eating sugar
      386 Birth deformities 387 (FEMALE) Poor sexual development 388 Underweight - no apparent weakness
      389 Epilepsy 390 Gout 391 Heart enlargement
      392 Heart defect in offspring 393 Failing eye sight 394 Various eruptions on the skin
      395 Schizophrenia 396 Green tinted urine 397 Absence of well being
      398 (FEMALE) Pregnant 399 Sore tongue 400 Throat infections


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