|
Digestive Track |
|
__Nausea
& vomiting
__Diarrhea
__Constipation
__Bloated
feeling
__Belching
or passing gas
__Stomach
pains or cramps
__Heartburn
__Blood
and/or mucous in stools
__Total |
|
Joints
& Muscles |
|
__Pains or
aches in joints
__Arthritis
__Stiffness
or limitation of movement
__Pain or
aches in muscles
__Feeling of
weakness or tiredness
__Swollen
tender joints
__Growing
pains in legs
__Total |
|
Head |
|
__Headaches
__Faintness
__Dizziness
__Insomnia,
sleep disorder
__Facial
flushing
__Total |
|
Mouth & Throat |
|
__Chronic
coughing
__Gagging,
frequently clearing throat
__Sore
throat, horseness, loss of voice
__Swollen or
discolored tongue
__Canker
sores
__Itching on
roof of mouth
__Total |
|
Weight |
|
__Binge
eating/drinking
__Craving
certain foods
__Excessive
weight
__Compulsive
eating
__Water
retention
__Total |
|
|
Eyes |
|
__Watery or
itchy eyes
__Red,
swollen or sticky eyelids
__Bags or
dark circles under eyes
__Blurred or
tunnel vision
__Total |
|
Nose |
|
__Stuffy
nose
__Chronically
red, inflamed nose
__Sinus
problems
__Hay fever
__Sneezing
attacks
__Excessive
mucous formation
__Total |
|
Emotions |
|
__Mood
Swings
__Anxiety,
fear, nervousness
__Anger,
irritability, aggressive
__Argumentative
__Frustrated,
cries often
__Depression
__Total |
|
Mind |
|
__Poor
memory
__Difficulty
completing projects
__Difficulty
with mathematics
__Underachiever
in school
__Poor/short
attention span
__Confusion
__Easily
distracted
__Difficulty
making decisions
__Learning
disabilities
__Total |
|
Lungs |
|
__Chest
congestion
__Asthma,
bronchitis
__Shortness
of breath
__Difficulty
in breathing
__Persistent
cough
__Wheezing
__Total |
|
|
Skin |
|
__Acne
__Itching
__Hives,
rash, dry skin
__Hair loss
__Flushing
or hot flashes
__Total |
|
Ears |
|
__Itchy ears
__Ear aches,
ear infections
__Drainage
from ear
__Ringing in
ears
__Hearing
loss
__Reddening
of ears
__Total |
|
Heart |
|
__Irregular
or skipped heartbeat
__Rapid or
pounding heartbeat
__Chest Pain
__Total |
|
Energy & Activity |
|
__Apathy,
lethargy
__Attention
deficit
__Fatigue
__Hyperactivity
__Restlessness
__Poor
physical coordination
__Stuttering
or stammering
__Slurred
speech
__Total |
|
Other |
|
__Frequent
illness
__Frequent
or urgent urination
__Genital
itch or discharge
__Anal
itching
__Total |
____Grand
Total
| Note: If your
total in any one category exceeds 10, or your grand total exceeds
50, we strongly recommend you get an IgG Food Sensitivity Test. |
|