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Diagnostic form

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Diagnostic questionnaire - here you can specify what is bothering you
Is your hair falling out?
Are your nails breaking?
Do you have dry skin?
Are you cold-hearted?
Are you hot-blooded?
Do you have flushes?
Are you experiencing any hot flashes?
Do you ever get a headache?
Do you suffer from cold sores?
Do you ever get dizzy?
Do you have high blood pressure?
Do you have low blood pressure?
Do you suffer from shortness of breath?
Do you get forgetful?
Do you ever cough?
Do you ever notice a heartbeat?
Are you having cramps?
Do you have a lump in your throat?
Do you suffer from recurrent sore throat?
Do you suffer from bloating?
Do you get tired after eating?
Do you have heartburn?
Do you have reflux?
Do you have a dry mouth?
Do you have dry lips?
Do you eat regularly?
Is the stool regular?
Is the stool soft and mushy?
Is the stool dry?
Is there a problem with stool expulsion?
Do you suffer from bladder inflammation?
Do you urinate too often?
Do you wake up to urinate during the night?
Are you tired?
Are you falling asleep well?
Do you wake up during the night or early in the morning?
Do you have dry or tired eyes?
Do you have tinnitus or ringing in your ears?
Do you have swelling?
Do you have regular periods?
Do you have a shorter cycle?
Do you have a longer cycle?
Do you have heavy menstruation?
Do you have weak menstruation?
Do you have pain before your period?
Do you suffer from premenstrual syndrome?
Are there gynecological discharges?
Do you have anxiety, depression, fears?
You gonna blow up easy?
Are you suppressing your emotions?
Vaccination for covid
Do you have an aversion to sex?
Fields with an asterisk are required.

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