Metabolic Stress Questionnaire

Your privacy is always respected. It’s important be honest and fill out the form completely as your customized program is based on your answers. Feel free to leave any notes of improvement or decline in the space provided.

Please rate each of the following symptoms based on your typical health profile for the past 60 days.

Point Scale:

0 - Never, or almost never have this symptom.

1 - Occasionally have it, but effect is NOT severe.

2 - Occasionally have it, but effect IS SEVERE.

3 - Frequently experience this, but effect is NOT severe.

4 - Frequently experience this, effect IS SEVERE.