Symptom questionnaire

1. You are unable to work (even if you have a job)?

2. Have you ever had a tick bite?

3. Have you ever had a scratch or bite from dogs/cats?

4. Are your symptoms periodic?

5. Is there a connection between your symptoms and menstrual cycle?

6. I came down with the illness after giving birth?

7. I came down with the illness after menopause?

8. I came down with the illness after the start of cessation of contraceptives?

9. Do you have enlarged and reactive lymph node?

10. Do you have cyst, polyp, myoma, endometriosis?

11. Blurry vision that changes and is not constant?

12. Hypersensitivity to smell, noise or light?

13. Tinnitus?

14. Sleep issues or insomnia?

15. Your day is worse if you sleep more than usual?

16. Symptoms temporarily improve after sports activity?

17. Unexplained sweating especially at night?

18. IR, drop in blood sugar level right after meals?

19. Internal tremor-like feeling?

20. Burning feet or hands?

21. Clumsy hand or legs?

22. Pain or sensitivity on the bottom of the feet?

23. Bone pain?

24. Muscle twitching, myalgia or unexplained sore muscle?

25. Issues with short term memory, search for words?

26. Brain fog, decreased cognitive function?

27. Mixing or skipping syllables, mystyping?

28. Unfounded panic, fear or anxiety?

29. My body has become my prison?

30. Weird bodily sensations tingling or tickling “from inside”?

31. Digestion issues, food intolernaces?

32. Skin issues such as lumps, nodules, cherry angiomas, scratch-marks?

33. Greasy hair, skin or ears beyond normal?

34. Pain that doesn’t respond to pain killers?

35. I have symptoms for which there are no words to describe?

36. I’ve had prior visits to psychiatrist, neurologist or rheumatologist?

37. I came down with this illness after getting the COVID shot or COVID?

38. Difficulty or issues with swallowing?