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Medical Symptom Questionnaire

Institute for Functional Medicine
“We Don’t Guess, We TEST!” — A 20-Year Doctrine

How to Rate Your Symptoms

Rate each symptom based upon your typical health profile for the past 30 days.

Tap the number that best describes your experience.

0 Never / Almost Never
1 Occasional, Not Severe
2 Occasional, Severe
3 Frequent, Not Severe
4 Frequent, Severe
0 of 71 symptoms rated

⚠ Important

This questionnaire allows our team to accurately assess your body’s symptom burden across 15 systems. Your honest responses help us build your personalized wellness pathway. This is not a diagnosis — it is a compass.

To Yahweh Be the Glory
Levity. Lethality. Legacy.
EpiGenetics USA — 1915 HWY 36 W, Suite 140, Roseville, MN 55113
This questionnaire is for wellness assessment purposes only and does not constitute medical diagnosis.
Compliant with Minnesota Statute §146A. © 2026 DanDurand Enterprises, Inc.
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