Today's Date:
How long have you had CFS? :
Symptoms of CFS
1. Do you have abdominal pain ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
2. Do you have alcohol intolerance ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
3. Do you have allergies ? Are you sensitive to medicines, inhalants, odors, and foods?
SUDS
0
1
2
3
4
5
6
7
8
9
10
4. Do you have altered taste, smell, hearing ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
5. Do you experience anxiety/panic attacks or seizures?
SUDS
0
1
2
3
4
5
6
7
8
9
10
6. Do you experience aphasia (inability to find
the right word, saying the wrong word) and/or dyscalculia
(difficulty with numbers)?
SUDS
0
1
2
3
4
5
6
7
8
9
10
7. Do you have a balance disturbance ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
8. Do you have a bitter or metallic taste in your mouth?
SUDS
0
1
2
3
4
5
6
7
8
9
10
9. Do you have
bladder/prostate problems , frequent urination ? Do you experience
burning during urination ? Do you experience incontinence ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
10. Do you experience bloating after meals?
SUDS
0
1
2
3
4
5
6
7
8
9
10
11. Do you have blurred vision , are your eyes scratchy ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
12. Do you have bouts of diarrhea or constipation ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
13. Do you bruise easily?
SUDS
0
1
2
3
4
5
6
7
8
9
10
14. Is your thyroid inflamed ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
15. Do you have a white coated tongue ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
16. Do you have carpal tunnel syndrome ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
17. Do you have chemical sensitivities ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
18. Do you have chest pain or even serious cardiac rhythm
disturbances?
SUDS
0
1
2
3
4
5
6
7
8
9
10
19. Are you cold most of the time?
SUDS
0
1
2
3
4
5
6
7
8
9
10
20. Do you have a chronic sore throat ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
21. Are you clumsy ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
22. Do you have problems concentrating or thinking clearly, feel spacey?
SUDS
0
1
2
3
4
5
6
7
8
9
10
23. Do you have a cough ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
24. Do you crave sugar or carbs ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
25. Do you have a decreased libido ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
26. Are you depressed ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
27. Do you have difficulty swallowing ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
28. Do you experience disequilibrium , spatial
disorientation, dizziness, vertigo?
SUDS
0
1
2
3
4
5
6
7
8
9
10
29. Do you have double vision or see "floaters" ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
30. Are your mouth and/or eyes too dry ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
31. Do you have frequent earaches ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
32. Do you have endometriosis ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
33. Do you experience episodic hyperventilation
or do you get short of breath easily?
SUDS
0
1
2
3
4
5
6
7
8
9
10
34. Do you have eye pain ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
35. Do you have fainting spells or blackout?
SUDS
0
1
2
3
4
5
6
7
8
9
10
36. Do you have extreme fatigue that alternates with periods of normalcy?
SUDS
0
1
2
3
4
5
6
7
8
9
10
37. Do you experience fatigue, often accompanied by
nonrestorative sleep , generally worsened by exertion?
SUDS
0
1
2
3
4
5
6
7
8
9
10
38. Do you have fevers/chills/sweats/feeling hot often?
SUDS
0
1
2
3
4
5
6
7
8
9
10
39. Do you have a flushing rash of the face and cheeks?
SUDS
0
1
2
3
4
5
6
7
8
9
10
40. Do you have frequent canker sores?
SUDS
0
1
2
3
4
5
6
7
8
9
10
41. Do you have a fungal infection of skin and nails?
SUDS
0
1
2
3
4
5
6
7
8
9
10
42. Have you experience unusual hair loss ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
43. Do you have hallucinations ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
44. Do you get headaches ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
45. Has your hearing changed?
SUDS
0
1
2
3
4
5
6
7
8
9
10
46. Do you experience heart palpitations ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
47. Do you have a heat/cold intolerance ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
48. Do you have hypoglycemia or hypoglycemia-like symptoms?
SUDS
0
1
2
3
4
5
6
7
8
9
10
49. Are you impotent ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
50. Do you have tinnitus ? (ringing in the ears)
SUDS
0
1
2
3
4
5
6
7
8
9
10
51. Do you have increased/severe PMS (premenstrual syndrome)?
SUDS
0
1
2
3
4
5
6
7
8
9
10
52. Do you suffer from insomnia ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
53. Do you have sinus pain ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
54. Do you have irritable bowel syndrome (diarrhea, nausea, gas, abdominal pain)?
SUDS
0
1
2
3
4
5
6
7
8
9
10
55. Do you have isolative tendencies ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
56. Do you have joint, neck, or muscle pain ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
57. Do you have low blood pressure ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
58. Do you have lymph node pain ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
59. Do you feel like you have the flu ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
60. Do you have short term memory problems ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
61. Do you have mitral valve prolapse ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
62. Do you experience mood swings , excessive irritability, overreaction?
SUDS
0
1
2
3
4
5
6
7
8
9
10
63. Do you experience muscle twitching, involuntary movements ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
64. Do you experience muscle weakness ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
65. Do you experience nausea or vomiting ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
66. Do you have night sweats ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
67. Do you have numbness and/or tingling in extremities ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
68. Do you have pain in teeth , loose teeth, and endodontal problems, periodontal (gum)
disease ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
69. Has your personality changed ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
70. Are you sensitive to light ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
71. Do you feel pressure at base of skull ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
72. Do you have a pressure sensation behind eyes?
SUDS
0
1
2
3
4
5
6
7
8
9
10
73. Do you have pyriform muscle syndrome , causing sciatica?
SUDS
0
1
2
3
4
5
6
7
8
9
10
74. Have you lost/gained weight without trying?
SUDS
0
1
2
3
4
5
6
7
8
9
10
75. Do you have TMJ syndrome (jaw pain or locking)?
SUDS
0
1
2
3
4
5
6
7
8
9
10
76. Have you experienced swelling of nasal
passages, swelling of the extremities or eyelids, swollen lymph glands, any
swelling, fluid retention?
SUDS
0
1
2
3
4
5
6
7
8
9
10
77. Do you have a systemic yeast/fungal infection?
SUDS
0
1
2
3
4
5
6
7
8
9
10
78. Do you experience temporary paralysis after sleeping?
SUDS
0
1
2
3
4
5
6
7
8
9
10
79. Do you have a subnormal body temperature ?
SUDS
0
1
2
3
4
5
6
7
8
9
10
80. Other symptom
SUDS
0
1
2
3
4
5
6
7
8
9
10
81. Other symptom
SUDS
0
1
2
3
4
5
6
7
8
9
10
82. Other symptom
SUDS
0
1
2
3
4
5
6
7
8
9
10
What do you think caused your CFS?
83. Toxic exposure
84. Toxic emotions
85. Lack of life goal
86. No idea
87. SAD diet
What have you tried?
88. Spit test for fungus overgrowth
89. Cut sugar out of diet
90. Cut processed foods out of diet
91. Don't eat soy
92. Avoid chemicals in diet including artificial sweeteners
93. Don't eat flour or wheat products
94. Raw food diet
95. Drug therapy
96. Vitamin therapy
97. Mineral supplements
98. Drink live/fresh spring water
99. Eat superfoods
100. Been tested for food allergies
101. Used alternative treatments such as zapper
102. Used colloidal silver ,
caprilic acid , or other health food store product
103. Water cure
104. Oxygen therapies
105. Emotional freedom technique
106. Spiritual growth
107. Positive thinking
108. Do something that brings me joy
frequently
109. Listen to happy, pleasant music
110. Get out in nature frequently
111. Growing a garden as Anastasia in
Ringing Cedars of Russia recommends
112. Other