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Do you experience, feel or have these things? Check the box if yes or no. Yes No 1 .Frequent urination 2. Tiredness 3. Always thirsty 4. Muscle cramps 5. Intense hunger 6. Depression 7. Sudden weight gain 8. Slow thoughts and movements 9. Sudden weight loss 10. Sensitivity to cold 11. Short neck 12. Confusion 13. Vision problems 14. Nervousness 15. Hearing problems 16. Fast heartbeat 17. Problems with joint movement 18. Nausea 19. A very short trunk 20. impatience

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Page 1: Do You Experience

Do you experience, feel or have these things? Check the box if yes or no.

Yes No

1 .Frequent urination

2. Tiredness

3. Always thirsty

4. Muscle cramps

5. Intense hunger

6. Depression

7. Sudden weight gain

8. Slow thoughts and movements

9. Sudden weight loss

10. Sensitivity to cold

11. Short neck

12. Confusion

13. Vision problems

14. Nervousness

15. Hearing problems

16. Fast heartbeat

17. Problems with joint movement

18. Nausea

19. A very short trunk

20. impatience

What do you think is the reason that caused this? Check the box if you think it is the reason.

1. Lifestyle 4. Recent conditions or sicknesses 2. Hereditary reasons 3. Skipping meals

Page 2: Do You Experience

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