More Than Sick of Salt

Autonomic Questionnaire

Please be advised that your information is 100% confidential




    1. LightheadedFainting and near faintingFatigueBrain Fog or Mental cloudinessDifficulty findings wordsShort term memory lossSensory: hypersensitive to light, sound, motion, touchPins and needs in arms/legsNumbness in hands and feetCoat hanger pain in neck and shouldersMigraine HeadacheTension headachesNausea, vomitingDifficulty standingChest pain, palpitationsShort of breathHypermobility joints- Joints pop outDepression, anxietySweat too muchSweat too littleSalivate too little, Dry mouthCold hands or feetDimmed visionDimmed hearing or ringing in earsDoes hot or cold weather bother you


    If you have checked several of the items above, you may have a form of Autonomic Dysfunction such as Postural Orthostatic Tachycardia Syndrome (POTS), Dysautonomia, Ehlers-Danlos Syndrome, Chroninc Fatigue Syndrome, etc.

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    Fore more information about Autonomic Dysfunction, Click Here