1. What is your body weight?

  • Normal, within a few pounds
  • 5 to 20 pounds overweight
  • More than 20 pounds overweight
  • 3 to 10 pounds underweight
  • More than 10 pounds underweight

2. Are you fatigued?

  • Yes, I’m always tired
  • Occasionally feel fatigued
  • Not often

3. Do you feel cold (prone to cold hands/feet) or uncomfortably warm at times?

  • I always feel cold
  • Hands or feet are often cold
  • I feel too warm
  • I do not feel too warm or too cold

4. Do you have trouble focusing or remembering names?

  • Yes, I frequently lose everyday items like keys and have memory problems
  • I sometimes have a problem with this
  • No problem

5. Do you experience bloating or other digestive issues?

  • Yes, I frequently experience bloating or other digestive issues
  • Yes, I sometimes have digestive problems
  • No, I do not have digestive issues

6. Have you noticed your hair or eyebrows thinning?

  • Noticeable loss or thinning
  • Thinning to some extent
  • No hair problems

7. Do you have trouble sleeping?

  • Yes, I always have trouble falling asleep or staying asleep
  • Yes, I sometimes have problems sleeping
  • No sleeping problem

If you answered “YES” to one or more of these questions, we recommend contacting us to schedule a thyroid consultation.