* = Required Information
Adrenal Fatigue Questionaire
I have not felt well since  when  
Predisposing Factors
PAST NOW  
I have experienced long periods of stress that have affected my well being
I have had one or more severely stressful events that have affected my well being.
I have driven myself to exhaustion.
I overwork with little play or relaxation for extended periods.
I have had extended, severe or recurring respiratory infections.
I tend to gain weight, especially around the middle (spare tire).
I have a history of alcoholism and/or drug abuse.
I have environmental sensivities
I have diabetes (type 2, adult onset, NIDDM)
I suffer from post traumatic distress syndrome.
I suffer from anorexia.*
I have one or more other chronic illness of diseases
Key Signs & Symptoms
PAST NOW  
My ability to handle stress and pressure has deceased.
I am less productive at work.
I seem to have decreased in cognitive ability. I don't think as clearly as I used to.
My thinking is confused when hurried or under pressure.
I tend to avoid emotional situations.
I tend to shake or am nervous when under pressure.
I suffer from nervous stomach indigestion when tense.
I have many unexplained fears/anxieties.
My sex drive is noticeably less than it used to be.
I get lightheaded or dizzy when rising rapidly from sitting or lying position.
I have feelings of graying or blacking out.
I am chronically fatigued; a tiredness that is not usually relieved by sleep.*
I feel unwell much of the time.
I notice that my ankles are sometimes swollen-the swelling is worse in the evening.
I usually need to lie down or rest after sessions of psychological or emotional pressure/stress.
My muscles sometimes feel weaker than they should.
My hands and legs get restless- experience meaningless body movements.
I have become allergic or have increased frequency/severity of allergic reactions.
When I scratch my skin, a white line remains for a minute or more.
Small irregular dark brown spots have appeared on my forehead, face, neck, and shoulders.
I sometimes feel weak all over.*
I have unexplained and frequent headaches.
I am frequently cold.
I have decreased tolerance for cold.*
I have low blood pressure.*
I often become hungry, confused, shaky, or somewhat paralyzed under stress.
I have lost weight without reason while feeling very tired and listless.
I have feelings of hopelessness or despair.
I have deceased tolerance. People irritate me more.
The lymph nodes in my neck are frequently swollen (swollen glands).
I have times of nausea and vomiting for no apparent reason.*

Security code