1. Tired in the morning
After lunch
After dinner
How long have you experienced this condition?
|
2. Need a nap after work/school/shopping - Under 1 hour
Over 1 hour
How long have you experienced this condition?
|
3. Need extra hours of sleep
Sleep poorly
How long have you experienced this condition?
|
4. Need to urinate during night - Once
More than once
How long have you experienced this condition?
|
5. Weak urinary flow
Delayed start
Dribbling
How long have you experienced this condition?
|
6. Frequent bowel movements after meals
How long have you experienced this condition?
|
7. Weakness or heaviness in extremities
Back
How long have you experienced this condition?
|
8. Poor appetite
Poor sense of taste
Frequent colds
How long have you experienced this condition?
|
9. Dry mouth
Frequent bitter taste in mouth
How long have you experienced this condition?
|
10. Tired vision
Weak vocal chords
Don't like to talk
How long have you experienced this condition?
|
11. Poor hair condition
Losing hair
How long have you experienced this condition?
|
12. Poor concentration
Poor memory
Nervous
How long have you experienced this condition?
|
13. Moody
Upset easily
Worry too much
How long have you experienced this condition?
|
14. Slow reaction time
Premature signs of aging
Poor coordination
How long have you experienced this condition?
|
15. Premature/weak ejaculation (men)
How long have you experienced this condition?
|
16. Difficulty reaching orgasm (women)
Can't reach an orgasm
How long have you experienced this condition?
|
17. If you'd like an herbal dietary supplement for your liver
How long have you experienced this condition?
|
18. If under any kind of tumor treatment and wish to use an herbal dietary supplement
How long have you experienced this condition?
|
19. If you'd like an herbal dietary supplement for high glucose
How long have you experienced this condition?
|
20. If you'd like an herbal dietary supplement for high cholesterol
How long have you experienced this condition?
|
21. If you'd like an herbal dietary supplement for rheumatoid arthritic pain
How long have you experienced this condition?
|
22. If you'd like an herbal dietary supplement for upset stomach
H. pylori positive
How long have you experienced this condition?
|
23. If you'd like an herbal dietary supplement for blemises (pimples)
How long have you experienced this condition?
|
24. If you'd like an herbal dietary supplement for flu/cold
How long have you experienced this condition?
|
25. If you'd like an herbal dietary supplement for chronic itch
How long have you experienced this condition?
|
26. Any other symptom(s)?
|
|