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 Stress Test
1.

1.

Need an alarm to wake up
2.

2.

Wake up tired and groggy
3.

3.

Don't feel like eating breakfast
4.

4.

Feel tired most of the day
5.

5.

Ears ring and other noise in ears
6.

6.

Cold hands and feet
7.

7.

Get dizzy or light headed after standing up quickly
8.

8.

When taking a test, you know the material but can't think of the answer
9.

9.

Wake up in the middle of the night with a pounding heart
10.

10.

Wake up in the middle of the night in a panic
11.

11.

Feel really tired and go to bed but can't get to sleep
12.

12.

Mind races at night
13.

13.

Feel paranoid
14.

14.

Feel like I just can't figure things out
15.

15.

Chronic allergy symptoms
16.

16.

Catch every cold and bug that comes around
17.

17.

Fluid balance problems - puffy and/or swollen hands, feet, or eyes
18.

18.

No romance for life
19.

19.

Always see the bad side or negatives of life
20.

20.

No thoughts for sex
21.

21.

High or low blood pressure
22.

22.

Fall asleep after eating
23.

23.

Constant fatigue
24.

24.

Excessive sweating
25.

25.

Can't eat when tired or stressed
26.

26.

Crave salt or salty foods
27.

27.

Vague nerve pains come and go
28.

28.

Nervous exhaustion/nervous breakdown
29.

29.

Joint pain/arthritis
30.

30.

Stomach ulcers, Colitis, Irritable Bowel Syndrome
31.

31.

Lack of self confidence
32.

32.

Have high financial debt
33.

33.

High emotional debt - to forgive or be forgiven
34.

34.

Emotionally drained - "my butt is dragging"
35.

35.

Anorexia or Bulimia
36.

36.

Vomiting or diarrhea for no reason
37.

37.

Fear of making a decision
38.

38.

Living in guilt
39.

39.

Repress your feelings and emotions
40. FOR GUYS ONLY #41-45:

40. FOR GUYS ONLY #41-45:

Smoothing and softening of skin
41.

41.

Fat goes to butt and thighs
42.

42.

Loss of sex drive - libido
43.

43.

Breast enlargement
44.

44.

Thin hair in armpits and groin
45. FOR GALS ONLY #46-50:

45. FOR GALS ONLY #46-50:

Facial hair growth and thick skin
46.

46.

Loss of curve and hips
47.

47.

Increase of menopausal symptoms: cold chills, night sweats, or insomnia
48.

48.

Depression, lack of sex drive
49.

49.

Nauseous feeling for no reason
50.

50.

Nervousness and anxiety
Please total up how many times you said yes. Click here to check out how stressed you are. You can click submit to get an overview of your results to print.

Updated 5/5/2011   

SYMPTOM SURVERY and DOCTOR'S CONSULTATION COST $50.00 

Paid by sending a check to:   Dr. Bernard Presser D.C.

2632 E. Larkspur Drive

Phoenix, AZ 85032


Password and Instructions are sent by e-mail once we have your name, phone number and e-mail address.

Results are sent to you by e-mail.  Consultation is done over the phone by a licensed chiropractor.

Your $50.00 will be applied to your first order of supplements from us making your Symptom Survey and Doctor's Consultation FREE.

 

If you have any questions, please contact us at 602-882-0648. 


 
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