Adrenal Fatigue Survey

I have experienced long periods of stress that have affected my well being.

I have had extended, severe or recurring respiratory infections.

I tend to gain weight, especially around the middle (spare tire).

I seem to have decreased in cognitive ability. I don’t think as clearly as I used to.

I get lightheaded or dizzy when rising rapidly from a sitting or lying position.

I am chronically fatigued; a tiredness that is not usually relieved by sleep.

My muscles sometimes feel weaker than they should.

I have decreased tolerance for cold.

I have difficulty getting up in the morning (don’t really wake up until about 10.00AM).

I often have an afternoon low between 3 and 5PM.

I usually feel my best after 6PM.

I sufrer from one or more of asthma, insomnia, fibromyalgia, hay fever or nervous breakdown.

I often use high fat foods and caffeine containing drinks (coffee, colas, chocolate) to drive myself.

I have low blood pressure.

I have become allergic or have increased frequency/severity of allergic reactions.


Thank you for completing the survey.
Please fill in the details below and a report of your result will be emailed to you.

This information will be used in order to send you the report of your results and for research purpose by Balm Naturopathy. Balm will also send occassional emails containing information on health and fatigue or specials offered by Balm Naturopathy, which can be unsubscribed from at any time.


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