fbpx

Symptoms list

Over the past few weeks, how often did you feel…

Emotional/physical symptoms

Tense

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Anxious

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always
Mental symptoms

A haze for the eyes

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Dizziness

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Confusion, or loss of sense of surroundings

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always
Respiratory irregularities

Faster or deeper breathing

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Respiratory distress

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Unable to breath deep enough

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always
Chest area

Chest pain

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Cramped in and around chest

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Palpitations

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always
Limbs

Tingling of fingers or arms

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Stiffness of fingers or arms

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Cold hands or feet

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always
Others

Bloating in abdomen

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always

Stiffness around the mouth

  • Never
  • Seldom
  • Sometimes
  • Often
  • Always