Symptoms Evaluation Assessment | Integrated Health Foundation

Do You Ever Experience Any of the Following?

• Neuropathy

• Numbness or tingling

• Issues with circulation

• Intense brain fog

• Chronic pain or fatigue

• Insomnia

• Random spikes in your heart rate

• Inconsistent blood pressure

• Low energy

• Chest pain

• Shortness of breath

• Histamine issues

• Poor sleep or intense dreams

If these symptoms sound familiar, you might be experiencing signs of nervous system dysregulation. It’s not uncommon for such symptoms to be interconnected, often pointing to underlying issues within your autonomic nervous system.

Take the first step toward understanding your symptoms and find out if they might be connected to a broader issue by completing our evaluation.

Click 'next' below to start the evaluation.

Before You Proceed with the Symptoms Evaluation, please note the following:

By taking this assessment, you acknowledge and understand that it is intended solely for educational use and does not provide a diagnosis.

Additionally, you consent to sharing your personal medical information with The Integrated Health Foundation. This information may be used to identify patterns in autonomic disorders. All personal medical details will remain confidential, and no individual data will be disclosed.

What is your first name? *

What is your last name? *

What is your date of birth? *

Have you received a diagnosis? *

Yes

No

If you did receive a diagnosis, by whom was it made? *

A local specialist (cardiologist, neurologist etc)

An autonomic specialist

A primary care doctor

Someone at the hospital

Select all that apply.

When did you receive the diagnosis? *

If you have not received a diagnosis, type 'none'.

Please list any other conditions that you have received a diagnosis for: *

If you have not received any other diagnosis, type 'none'.

Was there a specific event or period in your life when you first began to notice symptoms? *

Tell us if there was a time you started to notice your symptoms first develop, or if you can remember a particular event in your life when things started to change for you.

How often do you experience these symptoms? *

Everyday

From time to time

I have random major crashes

It’s hard to say

Ever since you started experiencing symptoms, have you had trouble with exercising? *

Exercising is very difficult for me

Walking is difficult for me

I find it hard to get up a flight of stairs

Whenever I try I get very short on breath

I can’t exercise like I used to

I’m too tired to try exercising

I have a severe crash and my symptoms get much worse after exercise

No issues with exercise

Select all that apply.

Have you recently experienced any issues with temperature? *

I find it hard to stay warm when it’s cold

I find it hard to stay cooler when it’s hot

I often feel faint when it’s warmer

I feel pins and needles in my hands or feet especially in the cold

I have other symptoms when it’s cold (please type)

No

Select all that apply.

How often do you experience these issues? *

Everyday

From time to time

I have random major crashes

It’s hard to say

Have you recently had any difficulty with any of the following activities? *

Doing basic household chores

Attending work or school

Being able to sleep at night

No

Select all that apply.

Have you recently been admitted to hospital? *

Yes

No

Are there any other symptoms you’re experiencing, or anything else you’d like to share with us at this time? *

What is your biological sex *

Male

Female

Rather not say

What is your phone number? *

Please share the email you would like us to send your evaluation results to? *

We will use this email to send you a report with your results.