lack of stamina
rapid weight gain, difficulty in losing weight
frequent abdominal bloating, indigestion
frequent diarrhea or loose stool
Tendency to bruise easily
low energy level most of the time
generalized puffiness
frequent cravings for sweet foods
obsessive desire for or dislike of foods
heavy fleshy arms and thighs
inflamed eyelids that tend to stick together
prolapses or hemorrhoids
Group A Total
Group B
Strongly identify with statement = 4
Somewhat identify with statement = 2
Indifferent to statement = 1
The tab key changes the active
field
I am:
I have:
excessive energy, especially at night
pain on the back of head and on temples
shoulder and neck tension
sciatic problems
oily skin, especially around nose
mood swings and / or PMS
indigestion caused by fatty foods
sudden blurring of vision, high pitch ringing in ear
headache, earache, neck stiffness from wind exposure
difficulty swallowing, throat feels tight
predisposition to tendonitis
cramping of calfs, twitching of eye, face
Group B Total
Group C
Strongly identify with statement = 4
Somewhat identify with statement = 2
Indifferent to statement = 1
The tab key changes the active
field
I am:
I have:
tight skin that cracks easily
lack of perspiration even in hot weather
chronic sore throat or hacking cough
congestion of nose and sinus
many small varicose veins
tendency to suffer from bronchitis or asthma attacks
morning cough with or without phlegm
shallow breathing
itching from dryness
sneezing or coughing due to change in air
temperature or moisture
dryness of nose, throat, skin, or hair
pain in the chest due to grief
Group C Total
Group D
Strongly identify with statement = 4
Somewhat identify with statement = 2
Indifferent to statement = 1
The tab key changes the active
field
I am:
I have:
insomnia when anxious or excited
fatigue with anxiety and restlessness
sore gum conditions, cold sores in mouth
skin eruptions, rash
dry scalp
the tendency to blush easily when nervous
heart palpitations
involuntary overheating, feeling flushed
cravings or thirst for cold liquids and foods
feelings of dizziness and disorientation when
startled
diminished long-term memory
burning sensation of urethra, vagina, or anus
Group D Total
Group E
Strongly identify with statement = 4
Somewhat identify with statement = 2
Indifferent to statement = 1
The tab key changes the active
field
I am:
I have:
pain in the arches, heels or soles of feet
loss of hair
dark circles under the eyes
diminished sexual energy or desire
loss of stamina
loose teeth
low back pain
impaired acuity of vision or of hearing
frequent, slow, at times difficult urination
stiffness or pain when getting up from sitting
bladder incontinence
loss of short-term memory
Group E Total
Now that you have completed the first step in
having taken the questionnaire, you are ready to
send us your results. Please email us at info@herbalbalance.com