|
Query 1-Describe your current energy level?:
Excessive- restless, fidgety (one answer only)
Normal
Deficient- tired, fatigue
Very Low/ Weak- exhausted, lethargic
Query 2-Describe your thermal nature?:
Hot-always warm (one answer only)
Normal
Cold- always cool
Alternating chills/ heat
Any Pain from head to toe?
Mutiple Selection Checkboxes:
hand, arm, or shoulder pain (check all that
apply)
foot, leg, or hip pain
back pain (upper and middle)
back pain (lower)
neck & head pain
menstrual pain
other pain (please describe in condition box
below)
Drop Down Selection:
|
