Symptom Survey Evaluation

Accurate, deep-level information on the causes of your health problems.

75 questions cover all major areas as they relate to your health problems.

Free phone consult: Talk to a doctor about detailed information from this test.

Health Test: Website LQE

Select how severe each symptom is, or leave blank if you don't experience the symptom:
- Severe (significant negative effect on your life)
- Moderate (frequent or bothersome)
- Mild (rare or not bothersome)
Liver/Digestion Category

Detoxification, fat metabolism and immune functions.
If you mark more than 5 of the symptoms in this category as Moderate or Severe, it can indicate basic problems in your body's ability to heal. This can affect many health problems. In your phone consult, ask the doctor for more detailed information on this, it may explain a lot of your health problems and why they don't improve.
1. High blood pressure
- Severe
- Moderate
- Mild
2. High cholesterol
- Severe
- Moderate
- Mild
3. Poor or excessive appetite
- Severe
- Moderate
- Mild
4. Blurred vision
- Severe
- Moderate
- Mild
5. Gas, bloating
- Severe
- Moderate
- Mild
6. Frequent skin rashes
- Severe
- Moderate
- Mild
7. Bloating
- Severe
- Moderate
- Mild
8. Bowel movements painful/hard
- Severe
- Moderate
- Mild
9. Heartburn, reflux
- Severe
- Moderate
- Mild
10. Constipation
- Severe
- Moderate
- Mild
11. Bad breath, (halitosis)
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Liver/Digestion Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Liver/Digestion Category
Adrenal Category

Stress handling, Blood sugar, Immune, Sex hormones and Fluid balance.
1. Dizziness
- Severe
- Moderate
- Mild
2. Sleep problems, can't wake up in mornings
- Severe
- Moderate
- Mild
3. Hot flashes
- Severe
- Moderate
- Mild
4. Food or environmental allergies
- Severe
- Moderate
- Mild
5. Hair growth on face or body (female)
- Severe
- Moderate
- Mild
6. Fatigue or exhaustion
- Severe
- Moderate
- Mild
7. Trouble getting to sleep or wakes in night
- Severe
- Moderate
- Mild
8. Crave sugar, carbs or junk foods
- Severe
- Moderate
- Mild
9. Allergies - tendency to asthma
- Severe
- Moderate
- Mild
10. Stressed, can't handle stress, anxiety
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Adrenals Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Adrenals Category
Heart/Cardiovascular Category

Circulation, energy levels.
1. In anyway aware of the heart
- Severe
- Moderate
- Mild
2. Sigh frequently, "air hunger"
- Severe
- Moderate
- Mild
3. Aware of "breathing heavily"
- Severe
- Moderate
- Mild
4. Afternoon "yawner"
- Severe
- Moderate
- Mild
5. Get "drowsy" often
- Severe
- Moderate
- Mild
6. Swollen ankles, worse at night
- Severe
- Moderate
- Mild
7. Muscle cramps, worse during exercise; get "charley horses"
- Severe
- Moderate
- Mild
8. Shortness of breath on exertion
- Severe
- Moderate
- Mild
9. Dull pain in chest or radiating into left arm, worse on exertion
- Severe
- Moderate
- Mild
10. Bruise easily, "black & blue" spots
- Severe
- Moderate
- Mild
11. Noises in head, or "ringing in ears"
- Severe
- Moderate
- Mild
12. Tension under breastbone, or feeling of "tightness", worse on exertion
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Heart/Cardiovascular Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Heart/Cardiovascular Category
Thyroid Category

Metabolic regulation, Heart rhythm, Brain function .
If you have more than 6 Moderate or Severe symptoms in this category, the doctor may have information for you about low-metabolism testing and solutions.
1. Increase in weight
- Severe
- Moderate
- Mild
2. Stubborn weight
- Severe
- Moderate
- Mild
3. Fatigue easily
- Severe
- Moderate
- Mild
4. Heart palpitations
- Severe
- Moderate
- Mild
5. Sleepy during day
- Severe
- Moderate
- Mild
6. Sensitive to cold, cold hands & feet
- Severe
- Moderate
- Mild
7. Dry or scaly skin
- Severe
- Moderate
- Mild
8. Constipation
- Severe
- Moderate
- Mild
9. Mental sluggishness, lethargy
- Severe
- Moderate
- Mild
10. Hair coarse, falls out
- Severe
- Moderate
- Mild
11. Flabby skin under neck and arms
- Severe
- Moderate
- Mild
12. Anxiety
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Thyroid Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Thyroid Category
Female Sex Hormones Category

Sex hormones affect overall health: emotions, weight, skin/hair/nails as well as menstrual cycle, fertility and menopause.
1. PMS
- Severe
- Moderate
- Mild
2. Depressed feelings before period
- Severe
- Moderate
- Mild
3. Painful breasts
- Severe
- Moderate
- Mild
4. Irregular periods
- Severe
- Moderate
- Mild
5. Infertility
- Severe
- Moderate
- Mild
6. Hysterectomy (Check Severe)
- Severe
- Moderate
- Mild
7. Hot flashes or night sweats
- Severe
- Moderate
- Mild
8. Low or no libido
- Severe
- Moderate
- Mild
9. Depression of long standing
- Severe
- Moderate
- Mild
10. Skin: Acne, Breakouts
- Severe
- Moderate
- Mild
11. Skin: Wrinkles, Flabby
- Severe
- Moderate
- Mild
12. Thin, brittle nails
- Severe
- Moderate
- Mild
13. Thin, brittle hair or slow hair growth
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Female Sex Hormones Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Female Sex Hormones Category
Male Sex Hormones Category

Sex hormones affect muscle tone and energy and emotions as well as sex functions.
1. Urination difficult or dribbling
- Severe
- Moderate
- Mild
2. Night urination frequent
- Severe
- Moderate
- Mild
3. Lack of vigor and vitality
- Severe
- Moderate
- Mild
4. Leg nervousness at night
- Severe
- Moderate
- Mild
5. Erectile dysfunction
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Male Sex Hormones Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Male Sex Hormones Category
Blood Sugar Category

Blood sugar affects fatigue, sleep, cravings and irritability.
If you mark 5 or more of the symptoms in this category as Moderate or Severe, the doctor may have information for you about how unstable blood sugar could be creating hormone problems. Blood sugar has a surprising influence on hormones... ask the doctor during your consult.
1. Eat when nervous
- Severe
- Moderate
- Mild
2. Get "shaky" or irritable if hungry
- Severe
- Moderate
- Mild
3. Afternoon headaches
- Severe
- Moderate
- Mild
4. Afternoon craving of sweets, carbs, coffee
- Severe
- Moderate
- Mild
5. Moods of depression - "blues"
- Severe
- Moderate
- Mild
6. Tired in afternoons
- Severe
- Moderate
- Mild
7. Acne or boils
- Severe
- Moderate
- Mild
8. Thirsty all the time
- Severe
- Moderate
- Mild
9. Eating improves fatigue
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Blood Sugar Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Blood Sugar Category
Just two more sections to go!

Allergies Category

Allergies affect digestive health, immune health and inflammation levels as well as concentration and memory.
1. Picky eater or poor appetite
- Severe
- Moderate
- Mild
2. Difficulty focusing
- Severe
- Moderate
- Mild
3. Memory problems
- Severe
- Moderate
- Mild
4. Skin rashes or hives
- Severe
- Moderate
- Mild
5. Behavior problems
- Severe
- Moderate
- Mild
6. Fibromyalgia or muscle pain
- Severe
- Moderate
- Mild
7. Developmental delay
- Severe
- Moderate
- Mild
8. Anxiety or depression
- Severe
- Moderate
- Mild
9. Joint pain
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Allergies Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Allergies Category
Immune System Category

Your Immune system affects your body's ability to heal, not just resistance to infections.
If you mark 3 or more symptoms in this category as Moderate or Severe, ask the doctor about possible immune stresses on your hormones. Often hormone problems originate in immune stress and then cascade into other areas such as the adrenals and thyroid. The doctor may be able to give you more detailed information on this.
1. Chronic yeast or fungus
- Severe
- Moderate
- Mild
2. Frequent urinary or bladder infections
- Severe
- Moderate
- Mild
3. Frequent ear or throat infections
- Severe
- Moderate
- Mild
4. Low resistance to illness
- Severe
- Moderate
- Mild
5. Chronic fatigue
- Severe
- Moderate
- Mild
6. Chronic sleep problems
- Severe
- Moderate
- Mild
Check one of the choices below to describe your health problems overall in this Immune System Category:
- Severe (Damaging my overall quality of life significantl)y
- Serious (My life would be greatly improved if this problem was gone)
- Moderate (This is a problem I would like to get rid of)
- Little (Very little problem with this category)
Immune System Category
Almost Done!
Below, please give the doctor some specific information about your most important health problem. The doctor analyzes your main problem compared to all the survey answers to determine likely causes. In your consult, the doctor will ask specific questions and will be able to make recommendations.
Enter your most important health problem below. When this problem is at its worst, describe the symptoms you experience.
How long ago was the VERY FIRST time you can recall having this problem?
What have you done so far to try to fix this problem?
Overall, is this problem tending to:
- Improve
- Stay the same
- Get worse
Is there anything else you feel would be important for the practitioner to know about this problem?
Your age
How to get your test results:
If you live in the Atlanta area and provide us with your phone number, one of our practitioners will call you and go over your test with you. There is no charge or obligation for this service. This is a professional, confidential health consultation. Your practitioner is there to help you with useful information, not to sell you any product or service. The consultation will take about 5-10 minutes. It's absolutely free and you are under no obligation.
Name (Required)*
First
Email (Required)*

We never share Email addresses, and that's a promise!
Phone (Required)*
Without your phone number, we can't get in contact with you for your consultation. Our receptionist may call you to set up a consultation time with the doctor, or the doctor may call you directly.
Zip Code (Required)*
YOUR PRIVACY: All submitted information is considered medical records and is protected under law from unauthorized disclosure. We are prohibited by law from releasing your name, address or phone to any other organization or person.
Get Our Newsletter!
Get the latest information on natural health issues, healthy food recipes, debunking nutrition myths, and much more, go ahead and sign up for our email newsletter.
- Yes! Sign me up for your newsletter!
Click the Button Below
Make sure you entered your phone number

Symptom Survey Evaluation

Accurate, deep-level information on the causes of your health problems.

Health Test: Website LQE

Liver/Digestion Category

Detoxification, fat metabolism and immune functions.

Adrenal Category

Stress handling, Blood sugar, Immune, Sex hormones and Fluid balance.

Heart/Cardiovascular Category

Circulation, energy levels.

Thyroid Category

Metabolic regulation, Heart rhythm, Brain function .

Female Sex Hormones Category

Sex hormones affect overall health: emotions, weight, skin/hair/nails as well as menstrual cycle, fertility and menopause.

Male Sex Hormones Category

Sex hormones affect muscle tone and energy and emotions as well as sex functions.

Blood Sugar Category

Blood sugar affects fatigue, sleep, cravings and irritability.

Just two more sections to go!

Allergies Category

Allergies affect digestive health, immune health and inflammation levels as well as concentration and memory.

Immune System Category

Your Immune system affects your body's ability to heal, not just resistance to infections.

Almost Done!

How to get your test results:

We never share Email addresses, and that's a promise!

Get Our Newsletter!

Share this:

Like this: