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There are many causes for each symptom listed below. One of the most common causes is the presence of parasites. Please circle the appropriate number next to each question.

A= Never or almost never have the symptom
B= Occasionally have it
C= Occasionally have it, effect is severe
D= Frequently have it, effect is not severe
E= Frequently have it, effect is severe
 
 
Name
A
B
C
D
E

Emotions
1.Irritability
0
1
2
3
4
2.Nervousness
0
1
2
3
4
3.Mood swings
0
1
2
3
4
4.Frequent crying
0
1
2
3
4
5.Aggressive behavior, i.e., road rage
0
1
2
3
4
6.Anxiety
0
1
2
3
4
7.Fear
0
1
2
3
4
8.Confusion
0
1
2
3
4
9.Depression
0
1
2
3
4
10.Suicidal thoughts
0
1
2
3
4

Skin
1.Increased sweating, ear wax, oily skin
0
1
2
3
4
2.Skin rashes
0
1
2
3
4
3.Brown spots on hands and face
0
1
2
3
4
4.Boils
0
1
2
3
4
5.Skin tags (small hanging warts)
0
1
2
3
4
6.Acne
0
1
2
3
4
7.Eczema
0
1
2
3
4
8.Fever blisters Warts
0
1
2
3
4

Ear, Nose and Throat
1.Increased salivation
0
1
2
3
4
2.Mouth ulcers
0
1
2
3
4
3.Common cold
0
1
2
3
4
4.Sinusitis
0
1
2
3
4
5.Sore throats
0
1
2
3
4
6.Ear infections
0
1
2
3
4
7.Hay fever
0
1
2
3
4
8.Loss of smell
0
1
2
3
4
9.Cough
0
1
2
3
4

Mind and Brain
1.Hyperactivity
0
1
2
3
4
2.Stammering when speaking or problem finding words
0
1
2
3
4
3.Difficulty in concentration
0
1
2
3
4
4.Difficulty in making decisions
0
1
2
3
4
5.Headache
0
1
2
3
4
6.Poor memory
0
1
2
3
4
7.Poor coordination
0
1
2
3
4
8.Compulsive behavior
0
1
2
3
4
9.Sleep disturbance
0
1
2
3
4
10.Memory loss
0
1
2
3
4

Digestive System
1.Loose stools
0
1
2
3
4
2.Diarrhea
0
1
2
3
4
3.Heartburn
0
1
2
3
4
4.Constipation
0
1
2
3
4
5.Bloating
0
1
2
3
4
6.Abdominal pain
0
1
2
3
4
7.Intolerance to certain foods
0
1
2
3
4
8.Nausea or vomiting
0
1
2
3
4
9.Severe diarrhea with blood or mucous
0
1
2
3
4

Kidney
1.Increase in urination frequency and amount
0
1
2
3
4
2.Needing to get up in the night to pass urine
0
1
2
3
4
3.Urinary tract infections and cystitis
0
1
2
3
4
4.Kidney stones
0
1
2
3
4
5.Blood in the urine
0
1
2
3
4

Joints and Muscles
1.Fleeting muscle aches or joint aches
0
1
2
3
4
2.Tendinitis (e.g., tennis elbow, golfer's elbow, achilles tendinitis)
0
1
2
3
4
3.Gout
0
1
2
3
4
4.Arthritis
0
1
2
3
4
5.Fibromyalgia
0
1
2
3
4

Metabolism
1.Feeling of coldness
0
1
2
3
4
2.Hypoglycemia
0
1
2
3
4
3.Craving certain foods
0
1
2
3
4
4.Water retention
0
1
2
3
4
5.Obesity
0
1
2
3
4
6.Cellulite
0
1
2
3
4

 
Total (A + B + C + D ): 0
 
 
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