Adrenal-Fuel™ Stress Recovery Formula: Symptom Survey

Adrenal-Fuel™

Stress Recovery Formula

Symptom Survey

 

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!

 

Symptom Survey

Adrenal Exhaustion

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

 

Symptoms  Start  1-week  2-weeks  4-weeks
Fatigue and lack of energy _____ _____ _____ _____
Inability to lose weight _____ _____ _____ _____
Food cravings and blood sugar problem _____ _____ _____ _____
Food or airborne allergies _____ _____ _____ _____
Poor recovery from illness _____ _____ _____ _____
Headaches _____ _____ _____ _____
Difficulty with PMS or menopause _____ _____ _____ _____
Inability to concentrate or focus _____ _____ _____ _____
Difficulty sleeping or insomnia _____ _____ _____ _____
Depression, mood swings, irritability _____ _____ _____ _____
Mid-afternoon slumps _____ _____ _____ _____
Difficulty building muscle and tone _____ _____ _____ _____
Recovery from exercise _____ _____ _____ _____