Point Scale:
0 = Never or almost never have the symptom
1 = Occasionally have it, effect is not severe
2 = Frequently have it, effect is not severe
3 = Occasionally have it, effect is severe
4 = Frequently have it, effect is severe

Digestive Tract
Nausea or Vomiting:	0 1 2 3 4
Diarrhea:	0 1 2 3 4
Constipation:	0 1 2 3 4
Bloated Feeling:	0 1 2 3 4
Belching or Passing Gas:	0 1 2 3 4
Heartburn:	0 1 2 3 4
Ears
Itchy Ears:	0 1 2 3 4
Ear Aches, Ear Infections:	0 1 2 3 4
Drainage from Ears:	0 1 2 3 4
Ringing in Ears, Hearing Loss:	0 1 2 3 4
Emotions
Mood Swings:	0 1 2 3 4
Anxiety, Fear or Nervous:	0 1 2 3 4
Anger, Irritable, Agressive:	0 1 2 3 4
Depression:	0 1 2 3 4
Energy & Activity
Fatigue, Sluggishness:	0 1 2 3 4
Apathy, Lethargy:	0 1 2 3 4
Hyperactivity:	0 1 2 3 4
Restlessness:	0 1 2 3 4
Eyes
Watery or Itchy Eyes:	0 1 2 3 4
Swollen Reddened/Sticky Eyes:	0 1 2 3 4
Bags/Dark Circles Under Eyes:	0 1 2 3 4
Blurred or Tunnel Vision:	0 1 2 3 4
Head
Headaches:	0 1 2 3 4
Faintness:	0 1 2 3 4
Dizzyness:	0 1 2 3 4
Insomnia:	0 1 2 3 4
Heart
Irregular or Skipped Heartbeat:	0 1 2 3 4
Rapid or Pounding Heartbeat:	0 1 2 3 4
Chest Pain:	0 1 2 3 4
Joints/Muscles
Pains or Aches in Joints:	0 1 2 3 4
Arthritis:	0 1 2 3 4
Stiffness or Limited Movement:	0 1 2 3 4
Pain or Aches in Muscles:	0 1 2 3 4
Feeling Weak or Tired:	0 1 2 3 4
Lungs
Chest Congestion:	0 1 2 3 4
Asthma, Bronchitis:	0 1 2 3 4
Shortness of Breath:	0 1 2 3 4
Difficulty Breathing:	0 1 2 3 4
Mind
Poor Memory:	0 1 2 3 4
Confusion, Poor Comprehension:	0 1 2 3 4
Difficulty Making Decisions:	0 1 2 3 4
Stuttering or Stammering:	0 1 2 3 4
Slurred Speech:	0 1 2 3 4
Learning Disabilities:	0 1 2 3 4
Mouth/Throat
Chronic Coughing:	0 1 2 3 4
Gagging/Frequently Need to Clear Throat:	0 1 2 3 4
Sore Throat, Hoarse/Lost Voice:	0 1 2 3 4
Swollen or Discolored Tongue, Gums, or Lips:	0 1 2 3 4
Canker Sores:	0 1 2 3 4
Nose
Stuffy Nose:	0 1 2 3 4
Sinus Problems:	0 1 2 3 4
Hay Fever:	0 1 2 3 4
Sneezing Attacks:	0 1 2 3 4
Excessive Mucus Formation:	0 1 2 3 4
Skin
Acne:	0 1 2 3 4
Hives, Rashes, Dry Skin:	0 1 2 3 4
Hair Loss:	0 1 2 3 4
Flushing or Hot Flashes:	0 1 2 3 4
Excessive Sweating:	0 1 2 3 4
Weight
Binge Eating:	0 1 2 3 4
Craving Certain Foods:	0 1 2 3 4
Excessive Weight:	0 1 2 3 4
Compulsive Eating:	0 1 2 3 4
Water Retention:	0 1 2 3 4
Underweight:	0 1 2 3 4
Other
Frequent Illness:	0 1 2 3 4
Frequent or Urgent Urination:	0 1 2 3 4
Genital Itch or Discharge:	0 1 2 3 4

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