Adrenal Function Questionnaire

ADRENAL FUNCTION QUESTIONNAIRE

 

1pt

  1. Do you frequently have low body temperature (<98.0).
  2. Do you frequently get irritable?
  3. Do yo have poor memory or concentration?
  4. Do you notice palpitations?
  5. Do you suffer from allergies or asthma?
  6. Do you bruise easily or find your wounds heal slowly?
  7. Do you get frequent or chronic infections?
  8. Do you have dry thinning skin?
  9. Do you get headaches?
  10. Do you have unexplained hair loss?
  11. Do you skip meals?
  12. Do you exercise more than one time each week?
  13. Do you have thyroid problems?
  14. Is your energy good all day?
  15. Do you need caffeine in morning or after lunch?

3pt

  1. Are you emotionally overstressed?
  2. Do you get tenderness across the lower back?
  3. Do you suffer from depression or down moods?
  4. Do you have low blood pressure?
  5. Do you experience a “second wind” (high energy) at bedtime?
  6. Do you experience chronic or recurrent inflammation?
  7. Do you get light headed when sitting up or standing?

5pt

  1. Do you suffer from chronic pain?
  2. Do you suffer from low blood sugar/hypoglycemia?
  3. Do you suffer from insomnia?
  4. Do you experience symptoms of PMS? (breast tenderness, cramping, heavy periods, mood swings)
  5. Are you menopausal or peri-menopausal?