Questionnaire

Quick Symptom Check (12 items)

Complete this free guided questionnaire based on the symptoms you have experienced during the past 30 days. At the end, share your contact details to receive your result and request follow-up from our team.

Important safety notice

This questionnaire is not monitored in real time and is not an emergency service. It does not provide a medical diagnosis. If you are currently experiencing chest pain, severe difficulty breathing, sudden neurological symptoms, or another medical emergency, call 911 or seek immediate medical care. If you are in emotional crisis or considering harming yourself, call or text 988. If you are outside the United States, contact your local emergency services.

0 of 12 questions answered

0%

How to answer

Over the past 30 days, how often? Rate each item from 0 (Never) to 4 (Almost always).

0 — Never

1 — Rarely

2 — Sometimes

3 — Often

4 — Almost always

About your score

The total goes from 0 to 48 and shows how often these signals show up in your daily life. It is not a diagnosis.

Sleep & nervous system

0/12

Trouble sleeping (insomnia)

Trouble relaxing

Heart palpitations

Digestion

0/12

Bloating

Belching or gas

Heartburn

Pain

0/8

Joint pain

Muscle pain

Energy

0/8

Fatigue or sluggishness

Weakness or general tiredness

Emotional

0/8

Mood swings

Anxiety, fear or nervousness

Total

0/480%

12 questions left to answer.

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