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Diagnostic form

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Diagnostic questionnaire (here you can specify your problem)
 
Does your hair fall out?
Do your nails break?
Do you have dry skin?
Are you cold-blooded?
Are you hot-blooded?
Do you have hot flushes?
Do you have any heat symptoms?
Do you suffer from headaches?
Do you suffer from cold sores?
Does your head ever spin?
Do you have high blood pressure?
Do you have low blood pressure?
Do you suffer from breathlessness?
Are you ever phlegmy?
Do you sometimes cough?
Do you sometimes notice your heart beating?
Do you get cramps?
Do you feel a lump in your throat?
Do you suffer from a recurring sore throat?
Do you suffer from bloating?
Are you tired after eating?
Do you suffer from heartburn?
Do you have reflux?
Do you have a dry mouth?
Do you have dry lips?
Do you eat regularly?
Are your stools regular?
Are your stools soft and mushy?
Are your stools dry?
Is there a problem with stool extrusion?
Are you suffering from bladder inflammation?
Are you urinating too often?
Do you wake up during the night to go to urinate?
Are you tired?
Do you fall asleep ok?
Do you wake up during the night or early in the morning?
Do you have dry or tired eyes?
Do you feel a rumbling or thudding in your ears?
Do you have swelling?
Do you have a regular menstrual period?
Do you have a shorter cycle?
Do you have a longer cycle?
Do you have a strong menstrual period?
Do you have a weak menstrual period?
Do you have pain before menstruation?
Do you suffer from premenstrual syndrome?
Do you have gynaecological discharges?
Do you suffer from anxiety, depression and fears?
Do you lose your temper easily?
Do you suppress your emotions?
Are you reluctant to have sexual intercourse?
Fields with an asterisk are required.

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