energy Name * First Name Last Name Email * Phone * (###) ### #### Message Do you routinely feel a fatigue you can't explain or justify? * Yes No Are eight hours of sleep not enough for today? * Yes No Do you get muscle pain after even moderate exercise or activity? * Yes No Often feel brain fog? * Yes No Do you have trouble walking comfortably up a flight of stairs? Are you excessively winded when doing so? * Yes No Ever find that you just can't tolerate disturbances around you that you used to be able to ignore or dismiss or manage? * Yes No Do you lack ambition or have low energy? * Yes No Do you worry about undertaking an activity that incorporates exercise because you know you will not feel good afterward? * Yes No Are you often bone-weary? * Yes No Do you feel you do not have the energy to cope with the issues of daily living? * Yes No Do you frequently get headaches for no reasons? * Yes No Have your senses of smell and taste gotten worse? * Yes No Are you forgetting things you should not be forgetting? * Yes No Do you feel older than your age? * Yes No Does a regular old cold wipe you out for a prolonged period of time? * Yes No Thank you!