Chronic Inflammation Survey
Below is your Chronic Inflammation Survey. Please carefully review and respond to each question by hovering over and clicking on your chosen answers provided below. After answering all questions, click the submit button located at the bottom of the page.
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1) Headaches
2) Dizziness
3) Insomnia
4) Faintness
5) Itchy ears
6) Ringing in ears/loss of hearing
7) Earaches/ear infections
8) Drainage from ear
9) Bags or dark circles under eyes
10) Watery or itchy eyes
11) Swollen, reddened, or sticky eyelids
12) Blurred or tunnel vision (excluding near- or far- sightedness)
13) Stuffy nose
14) Sinus congestion, sinus infection
15) Constant sneezing
16) Hay fever/allergies
17) Excess mucus formation
18) Chronic coughing
19) Sore throat, hoarseness, loss of voice
20) Gagging, frequent need to clear throat
21) Swollen tongue, gums or lips
22) Swollen lymph nodes
23) Canker sores, mouth ulcers
24) Chest pain
25) Irregular or skipped heartbeat
26) Rapid or pounding heartbeat
27) Asthma, bronchitis
28) Chest congestion
29) Shortness of breath
30) Difficulty breathing
31) Acne or brown “age/liver spots
32) Hives, rashes, cysts, boils
33) Eczema or psoriasis
34) Itchy skin/dermatitis
35) Hair loss, hair thinning
36) Body odor
37) Excessive sweating
38) Pain or aches in joints or lower back
39) Stiffness or limitation of movement
40) Arthritis
41) Pain or aches in muscles
42) Poor memory
43) Difficulty concentrating
44) Mood swings
45) Depression
46) Anxiety, fear or nervousness
47) Anger, irritability, or aggressiveness
48) Insomnia
49) Fatigue/low energy
50) Restlessness
51) Hyperactivity
52) Feeling of weakness
53) Underweight
54) Overweight
55) Difficulty losing weight
56) Crave certain foods
57) Nausea, vomiting
58) Diarrhea
59) Constipation
60) Bloated feeling
61) Belching, passing gas
62) Heartburn
63) Intestinal/stomach pain
64) PMS
65) Frequent colds, flus
66) Chemical or environmental sensitivities
67) Food allergies/sensitivities