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Formularz diagnostyczny
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Are you on any medication?
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Describe your problem
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Maksymalny rozmiar pliku to %size% MB.
Diagnostic questionnaire (here you can specify your problem)
Does your hair fall out?
without an answer
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often
continuously
Do your nails break?
without an answer
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continuously
Do you have dry skin?
without an answer
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continuously
Are you cold-blooded?
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continuously
Are you hot-blooded?
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Do you have hot flushes?
without an answer
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Do you have any heat symptoms?
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Do you suffer from headaches?
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continuously
Do you suffer from cold sores?
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often
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Does your head ever spin?
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often
continuously
Do you have high blood pressure?
without an answer
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often
continuously
Do you have low blood pressure?
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Do you suffer from breathlessness?
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continuously
Are you ever phlegmy?
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often
continuously
Do you sometimes cough?
without an answer
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sometimes
often
continuously
Do you sometimes notice your heart beating?
without an answer
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often
continuously
Do you get cramps?
without an answer
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often
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Do you feel a lump in your throat?
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Do you suffer from a recurring sore throat?
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continuously
Do you suffer from bloating?
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Are you tired after eating?
without an answer
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continuously
Do you suffer from heartburn?
without an answer
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often
continuously
Do you have reflux?
without an answer
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continuously
Do you have a dry mouth?
without an answer
never
sometimes
often
continuously
Do you have dry lips?
without an answer
never
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continuously
Do you eat regularly?
without an answer
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Are your stools regular?
without an answer
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Are your stools soft and mushy?
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Are your stools dry?
without an answer
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Is there a problem with stool extrusion?
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Are you suffering from bladder inflammation?
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Are you urinating too often?
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Do you wake up during the night to go to urinate?
without an answer
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often
continuously
Are you tired?
without an answer
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often
continuously
Do you fall asleep ok?
without an answer
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continuously
Do you wake up during the night or early in the morning?
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often
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Do you have dry or tired eyes?
without an answer
never
sometimes
often
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Do you feel a rumbling or thudding in your ears?
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often
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Do you have swelling?
without an answer
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Do you have a regular menstrual period?
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continuously
Do you have a shorter cycle?
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Do you have a longer cycle?
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sometimes
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continuously
Do you have a strong menstrual period?
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Do you have a weak menstrual period?
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continuously
Do you have pain before menstruation?
without an answer
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often
continuously
Do you suffer from premenstrual syndrome?
without an answer
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continuously
Do you have gynaecological discharges?
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often
continuously
Do you suffer from anxiety, depression and fears?
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often
continuously
Do you lose your temper easily?
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often
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Do you suppress your emotions?
without an answer
never
sometimes
often
continuously
Are you reluctant to have sexual intercourse?
without an answer
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