B12 Insufficiency Questionaire

B12 Insufficiency Questionaire

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* Name & Surname
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Condition
Mark the box with an X if YES
1.
Tired or have weakness?
2.
Numbness, tingling, "asleep-feeling" in hands or feet?
3.
Poor concentration, poor memory, brain fog?
4.
Tongue swollen (imprint of teeth on edges), or sore?
5.
Skin too pale?
6.
Feel down and depressed?
7.
Fingernails, toenails brittle, chip, ridged?
8.
Dizzy, lightheaded? Vertigo?
9.
Weight loss without intent?
10.
Inside lower eyelid white/pale?
11.
Tummy troubles - gas, indigestion, bloating?
12.
Sudden Diarrhea occurs frequently?
13.
Chilly, cold hands and feet?
14.
Headaches, frequent?
15.
Observe a no-meat, vegetarian lifestyle?
16.
Often drink alcohol, often excessive?
17.
Diagnosed disease: Crohn's, Celiac, Irritable bowel?
18.
Shortness of breath on simple exercise?
19.
Unrefreshing sleep, trouble sleeping?
20.
Heart palpitations, irregular heartbeat?
21.
Easily bruised skin?
22.
Tinnitus, ringing in ears?
23.
Balance lapses, bumps into things, unsteady
24.
Loss of skin pigmentation, autoimmune
25.
Dry skin, or eczema, or psoriasis