MEDICAL SYMPTOM / TOXICITY QUESTIONNAIRE

The Toxicity and Symptom Screening Questionnaire identifies symptoms that help to identify the underlying causes of illness, and helps you track your progress over time. Rate each of the following symptoms based upon your health profile for the past 30 days. If you are completing this after your first time, then record your symptoms for the last 48 hours ONLY.


MSQ Guide "Working with a Functional Medicine Practitioner"

Functional Medicine practitioners promote wellness by focusing on underlying factors that infuence every patient’s experience of health and disease. Please read this document before proceeding with your Medical Symptom Questionnaire.

TAKE THE MSQ

< 10 Ideal

10-50 Mild imbalance

50-100 Moderate imbalance

>100 Severe imbalance