Please copy and paste this, and write in the answers and send it to me at email@example.com
What is your biggest complaint/s?
When did the problem begin?
Secondary or other complaints?
To what extent does your problem interfere with your daily life, sleep, exercize?
Have you been diagnosed for the problem? If so what?
How is your digestion? appetite, bowel regularity, constipation? Diahrea?
How is your energy?
Catch colds easily? or allergies? either airborn or digestive?
Depression, irritability, anxiety or anger?
Feelings of numbness or tingling?
Are you hot or cold all the time?