Complete Oriental Medical Care
5841 Pleasant Ave South
Minneapolis, MN 55419
612-
Simply print out this health quiz and then rate each of the following symptoms from zero to four. Add up your points,
If you score 25 or more (or 10 or more in any one category) you are a great candidate for this program. Please be
totally honest, this is your health! Enter one of the following numbers next to each symptom.
0 – Never or almost never have the symptom 3 – Frequently has it, effect is not
severe
1 – Occasionally has it, effect is not severe 4 – Frequently has it, effect
is severe
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Fatigue, sluggishness |
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Apathy |
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Hyperactivity |
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Restlessness |
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Total Score |
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Itchy ears |
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Earaches, ear infections |
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Drainage from ears |
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Ringing in ears, hearing loss |
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Total Score |
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Chronic coughing |
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Gagging, need to clear throat |
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Sore throat, hoarse |
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Swollen or discolored tongue, gums or lips |
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Canker sores |
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Total Score |
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Acne |
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Hives, rashes, dry skin |
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Hair loss |
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Flushing, hot flashes |
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Excessive sweating |
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Total Score |
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Stuffy nose |
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Sinus problems |
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Hay fever, allergies |
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Sneezing attacks |
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Excessive mucus |
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Total Score |
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Headaches |
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Faintness |
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Dizziness |
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Insomnia |
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Total Score |
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Poor Memory |
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Confusion |
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Poor concentration |
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Poor coordination |
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Difficulty making decisions |
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Stuttering, stammering |
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Slurred speach |
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Learning disabilties |
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Total Score |
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Skipped heartbeats |
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Rapid heartberats |
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Chest pain |
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Total Score |
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Pain or aches in joints |
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Arthritis |
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Stiff, limited movement |
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Pain, aches in muscles |
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Weakness or tiredness |
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Total Score |
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Binge eating/drinking |
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Craving certain foods |
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Excessive weight gain |
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Compulsive eating |
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Water retention |
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Underweight |
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Total Score |
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Frequent illness |
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Frequent, urgent urination |
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Genital itch, discharge |
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Total Score |
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Nausea or vomiting |
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Diarrhea |
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Constipation |
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Bloated Feeling |
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Belching, passing gas |
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Heartburn |
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Total |
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Mood swings |
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Anxiety, fear, nervous |
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Anger, irritability |
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Depression |
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Total |
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Watery, itchy eyes |
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Swollen, reddened, eyelids |
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Dark circles under eyes |
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Blurred, tunnel vision |
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Total Score |
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Chest congestion |
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Asthma, bronchitis |
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Shortness of breath |
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Difficulty breathing |
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Total Score |
For More Information Call 612-
or go to www.3StepDetox.com/Sonmore
Add the numbers to arrive at a total for each section, and then add the totals for each section to arrive
at the grand total. If you score 25 or more (or 10 or more in any one category) you are a great candidate
for this program.