BM Survey

Step 1: Patient History

To provide the most accurate analysis, please be patient and accurate in completing this confidential health history questionnaire. Your answers will help us determine the underlying causes of your condition. Thank you.

Main Complaint & Medical History

Please describe, in as much detail as possible, the reasons for your consultation*

Have you received care for this problem?

Yes No

Your Health Status

How many hours a night do you sleep?

How do you normally sleep?

Back Side Stomach

Exercise Frequency:

What types of exercise do you perform?

For Women Only

Are you pregnant?

Yes No

Are you currently nursing?

Yes No

Are your migraines linked to your menstrual cycle?

Yes No Unsure

Are you currently using hormonal contraception or HRT?

Yes No

Step 2: Complete the Questionnaires

Please complete both the Metabolic and Neurological questionnaires below. Your answers will be used to generate a personalized report of potential indication areas, along with recommended clinical exams and lab tests.

Metabolic Questionnaire

Neurological Questionnaire

Step 3: Your Personalized Report

Based on your questionnaire responses, the following are the top potential areas of physiological dysfunction that may be contributing to your symptoms. For each area, you will find a list of recommended in-person bedside examinations and additional laboratory tests to help confirm these findings with a qualified practitioner.

Neuro-Metabolic Analysis Tool

Step 1: Patient History

Main Complaint & Medical History

Headache Characteristics

General Medical & Lifestyle History

Your Health Status

For Women Only

Step 2: Complete the Questionnaires

Metabolic Questionnaire

Neurological Questionnaire

Step 3: Your Personalized Report

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