Heart_nerve Questionnaire
It's often difficult to pinpoint clear symptoms that identify spleen distress, the need for a gestalt or grouping of symptoms is used.

The fields denoted with * are compulsory fields

* Name & Surname
* Telephone
* Email

For each statement that applies to you, enter a ' X '.

1.
Anemia?
2.
Anorexia?
3.
Fatigue?
4.
Weakness?
5.
Easy bleeding? Easy bruising?
6.
Early fullness while eating? Stomach feels full even without eating?
7.
Painful left shoulder?
8.
Upper left sided abdominal pain?
9.
History of low blood platelet count?
10.
Have sickle cell disease?
11.
History of viral mononucleosis (Epstein Barr)?
12.
History of chronic bacterial, viral, parasitic, or fungal infections?
13.
Diagnosed with cirrhosis of the liver?
14.
Often have hiccups?
15.
Reduced or loss of appetite?
16.
Recent high fever, recurring high fevers?
17.
Body aches?
18.
Dizziness or sudden loss of balance?
19.
Frequent infections?
20.
Shortness of breath?