Shape Your Wellness Journey

Take Our Autoimmune Health Survey Today!

Your input helps us personalize your care plan, ensuring you get the best treatment for your autoimmune condition. Let’s make your next appointment even more effective!

Part 1: General Health and Family History

1. Do you have a family history of autoimmune diseases? *

Yes

No

I Don't Know

2. Do you experience prolonged or unexplained fatigue? *

Yes

No

3. Do you have recurring fevers or frequent infections? *

Yes

No

4. Have you noticed persistent joint pain, swelling, or stiffness? *

Yes

No

5. Do you have a history of allergies or asthma? *

Yes

No

Part 2: Symptom Evaluation

6. Do you experience unexplained weight changes (gain or loss)? *

Yes

No

7. Do you suffer from skin rashes, dryness, or other persistent skin issues? *

Yes

No

8. Have you experienced digestive issues (e.g., bloating, diarrhea, or constipation) that last for more than a few weeks? *

Yes

No

9. Do you have a sensitivity to cold or heat? *

Yes

No

10. Have you experienced hair loss or thinning? *

Yes

No

Part 3: Lifestyle and Environmental Factors

11. Do you have a history of chronic stress? *

Yes

No

12. Do you smoke or have you ever smoked? *

Yes

No

13. Do you consume a diet high in processed foods and sugars? *

Yes

No

14. Have you ever been diagnosed with a thyroid condition? *

Yes

No

Get The Results - Free Consultation

First Name *

Last Name *

Phone *

Email *