Symptom Quiz

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Symptom Quiz

It will take less than 5 minutes to complete this quiz. Please keep in mind this tool is intended to provide general information about your health. Always seek advice of your physician for any questions regarding a medical condition.

1
Hi there! What's your first name?* This field is required.We will keep your responses confidential as your privacy is important to us, please see our privacy policy here.
2
Would you like to receive health updates and tips via email?We promise to respect your inbox and will not email you things you do not wish to receive. Plus, you can opt-out at any time.
3
What's your gender?* This field is required.
Female
Male
4
How old are you? * This field is required.
5
Are you here for help with fertility?
YESNO
6
What brings you here today ?* This field is required.
I’ve been dealing with my symptoms for a while and need a solution
I’m experiencing new symptoms and looking for clarity
I'm looking for help with fertility
7
What symptoms are you experiencing?* This field is required.Check all that apply
Cough
Fever
Shortness of breath
None of these
8
What symptoms are you experiencing?Check all that apply
Runny nose
Body aches
Sore throat
UTI symptoms
Headache or head congestion
Pain
9
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10
We are sorry. but we are not currently equipped to assist with COVID-19.

We recommend you go through a formal screening process for testing by one of your local hospitals, clinics, or health systems.

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11
Please tell us how often or how severely you experience the following symptoms: Not sleeping well (trouble falling or staying asleep)
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
12
Moody or irritable
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
13
Decreased libido and sex drive
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
14
Anxious
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
15
Foggy brain, thinking, or memory
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
16
Dry eyes, hair, or dry skin
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
17
Fatigued, sluggish, or constantly tired
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
18
Thinning head hair
Not a problem for me
Minor
Mild
Moderate
Severe
19
Palpitations (skipped heart beats or heart pounding)
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
20
Hot flashes or night sweats
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
21
Vaginal dryness and painful sex
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
22
Excess body hair on face, chest, or arms
Not a problem for me
Minor
Mild
Moderate
Severe
23
Irregular menstrual cycles, heavy or painful periods
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
24
Sexual performance is not as good as it used to be
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
25
Decrease in strength and endurance
Not a problem or never true
Minor or seldom true
Mild or sometimes true
Moderate or often true
Severe or very frequent
26
Feeling less social
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
27
Must have caffeine or sugar to get or keep going
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
28
Catch more colds or takes longer to recover from illness
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
29
Feeling overwhelmed
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
30
Feeling tired and anxious (“tired and wired”)
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
31
Losing hair on eye brows or eyelashes
Not a problem or never true
Minor or seldom true
Mild or sometimes true
Moderate or often true
Severe or very frequent
32
Thin and brittle fingernails
Not a problem or never true
Minor or seldom true
Mild or sometimes true
Moderate or often true
Severe or very frequent
33
Cold hands and feet or feeling colder than everyone else
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
34
Constipation
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
35
Change in bowel movements (constipation or diarrhea)
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
36
Abdominal bloating, uncomfortable gas, indigestion, or heartburn
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
37
Certain foods cause abdominal discomfort or diarrhea
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
38
Have eczema or chronic skin rashes or itching
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
39
Unexplained weight gain, or difficulty losing weight
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
40
Have you been diagnosed autoimmune condition?
YESNO
41
Have you tried to become pregnant in the last 6 months unsuccessfully?
YESNO
42
Do you have a history of at least one miscarriage?
YESNO
43
Are you currently under the care of a fertility specialist (reproductive endocrinologist) and would like to enhance your chances of getting pregnant?
YESNO
44
Are you hoping to conceive naturally, without medications or procedures?
YESNO
45
Do you have a difficult time going to or staying asleep?
YESNO
46
Are you under a lot of stress?
YESNO
47
Have you noticed your hair thinning?
YESNO
48
Do you have irregular periods?
YESNO
49
Do you have very heavy periods?
YESNO
50
Do you have bothersome stomach symptoms like indigestion, heartburn, bloating, diarrhea, or constipation?
YESNO
51
How frequently do you feel exhausted?
Not a problem for me
Rarely
Sometimes
More often than not
Regularly
52
Have you gained weight around your belly?
Not a problem or never true
Minor or seldom true
Mild or sometimes true
Moderate or often true
Severe or very frequent
53
How soon are you looking to meet with a doctor to start resolving your symptoms?
As soon as possible
This week
This month
Not sure
54
How did you hear about us?
Social media
Searching online
Friend referral
55
How familiar are you with holistic and functional medicine?
Not at all familiar [I’m brand new to this]
Slightly familiar [I know a little about it]
Somewhat familiar [I’ve been researching and learning]
Moderately familiar [I’m using it now or have used it in the past]
Extremely familiar [I’m an expert, using it now, and tell others]
56
Thanks {hiThere}. What's your email?* This field is required.We need your email so we can email you the results and other useful health information.
example@example.com
57
What state do you live in?* This field is required.Your state will help us show you available clinicians in your area
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
58
We noticed that you did not check this box earlier. Please check this box in order to receive health updates and tips related to your quiz results via email.We promise to respect your inbox and will not email you things you do not wish to receive. Plus, you can opt-out at any time.
59
Would you like to speak to a care concierge from our team to learn more about Vytal Health and see if we are the right solution for you? * This field is required.We’re not telemarketers. Our promise to you is to keep the conversation around your needs.
YESNO
60
What's your phone number?
Area Code
Phone Number
61
Great 😃! Please scroll down 👇 to schedule an information call with our care concierge.You can finish your quiz and see your results after you schedule a time. Our care concierge works with our doctors and patients to help coordinate care and will answer all your questions so you can make the best decision for you and your health.
62
Opted in?
63
Your Hormone Balance Score (anything over 37 may indicate Hormonal Imbalance)
64
Your Adrenal Health Score (anything over 20 may indicate Adrenal Fatigue)
65
Your Thyroid Function Score (anything over 28 may indicate a Thyroid Disorder)
66
Your Gut Function Score (anything over 24 may indicate a gut imbalance)
67
Are you a human🙋‍♀️ or a robot 🤖* This field is required.
68
69
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