1. Have you taken tetracyclines (Sumycin, Panmycino, Vibramycin, Minocin, etc.) or other antibiotics for acne for one month (or longer)?
2. Have you, at any time in your life, taken other “broad spectrum” antibiotics* for respiratory, urinary, or other infections (for two months or longer, or in shorter courses four or more times in a one-year period)?
3. Have you taken a broad spectrum antibiotic drug*, even a single course?
4. Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs?
5. Have you been pregnant?
6. Have you taken birth control pills?
7. Have you taken prednisone, decadron or other cortisone-type drugs?
8. Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke symptoms?
9. Are your symptoms worse on damp, muggy days or in moldy places?
10. Have you had athlete’s foot, ringworm, “jock itch,” or other chronic fungus infections of the skin or nails?
13. Do you crave alcoholic beverages?
14. Does tobacco smoke really bother you?
2. Feeling of being “drained”
5. Feeling “spacey” or “unreal”
6. Inability to make decisions
7. Numbness, burning, or tingling
8. Muscle aches or weakness
9. Pain and/or swelling in joints
14. Troublesome vaginal burning, itching, or discharge
18. Loss of sexual desire or feeling
19. Endometriosis or infertility
20. Cramps and/or other menstrual irregularities
22. Attacks of anxiety or crying
23. Cold hands or feet and/or chilliness
24. Shaking or irritable when hungry
2. Irritability or jitteriness
4. Inability to concentrate
7. Dizziness/loss of balance
8. Pressure above ears, feeling of head swelling
9. Tendency to bruise easily
10. Chronic rashes or itching
12. Indigestion or heartburn
13. Food sensitivity or intolerance
17. Rash or blisters in mouth
19. Foot, body, or hair odor not relieved by washing
20. Nasal congestion or postnasal drip
23. Laryngitis, loss of voice
24. Cough or recurrent bronchitis
25. Pain or tightness in chest
26. Wheezing or shortness of breath
27. Urgency or urinary frequency
29. Spots in front of eyes or erratic vision
30. Burning or tearing of eyes
31. Recurrent infections or fluid in ears
