Medical Symptoms
Questionnaire (MSQ)

Rate each of the following symptoms based upon your typical health profile for the past 14 days.

Point Scale

0 – Never or almost never have the symptom
1 – Occasionally have it, effect is not severe
2 – Occasionally have it, effect is severe
3 – Frequently have it, effect is not severe
4 – Frequently have it, effect is severe


HEAD

EYES

EARS

NOSE

MOUTH/THROAT

SKIN

HEART

LUNGS

DIGESTIVE TRACT

JOINTS/MUSCLE

WEIGHT

ENERGY/ACTIVITY

MIND

EMOTIONS

OTHER