Thyroid Self Assessment

Complete this Assessment to help us learn more about your condition and how we can be of help.

1Are you Tired and Fatigued * 

2Do you have cold hands cold feet.* 

3Difficulty losing weight* 

4Constipation or difficult bowel movements* 

5Hair loss or Thinning of Hair* 

* This field is required.

 

Select the appropriate number. 0 never .. through 3 worst always

 

Select the appropriate number. 0 never .. through 3 worst always

 

Select the appropriate number. 0 never .. through 3 worst always

 

Select the appropriate number. 0 never .. through 3 worst always

 

Select the appropriate number. 0 never .. through 3 worst always