Adrenal-Fuel™ Stress Recovery Formula: Symptom Survey
Stress Recovery Formula
Thank you for choosing Adrenal-Fuel™ Stress-Recovery Formula! We are confident that you will experience positive results from the use of this state-of-the-art formula.
It will be beneficial for you to monitor your success, so you will be aware of the positive changes you can experience when you give your body the nutrients that support healthy adrenal & thyroid functions.
Please use the Survey below to document your improvements. We would love to hear about your success!
Please place a corresponding number for the symptoms listed below at the beginning of the program and again at the end of the first, second and fourth week.
0 = No occurrence, or does not apply
1 = Mild occurrence
2 = Moderate occurrence
3 = Severe occurrence
|Fatigue and lack of energy||_____||_____||_____||_____|
|Inability to lose weight||_____||_____||_____||_____|
|Food cravings and blood sugar problem||_____||_____||_____||_____|
|Food or airborne allergies||_____||_____||_____||_____|
|Poor recovery from illness||_____||_____||_____||_____|
|Difficulty with PMS or menopause||_____||_____||_____||_____|
|Inability to concentrate or focus||_____||_____||_____||_____|
|Difficulty sleeping or insomnia||_____||_____||_____||_____|
|Depression, mood swings, irritability||_____||_____||_____||_____|
|Difficulty building muscle and tone||_____||_____||_____||_____|
|Recovery from exercise||_____||_____||_____||_____|