Medical Symptoms Questionnaire (MSQ)
Privacy Notice: This MSQ is for personal, informational use only. No identifying information is collected, and your responses and score are not stored or reviewed by our practice.
Instructions
Use this point scale to rate each of the following symptoms based on your typical health profile for the last 30 days.
0 = Never or almost never have the symptom
1 = Occasionally have it; effect is not severe
2 = Occasionally have it; effect is severe
3 = Frequently have it; effect is not severe
4 = Frequently have it; effect is severe
Head
Total: 0
Eyes
Total: 0
Ears
Total: 0
Nose
Total: 0
Mouth and Throat
Total: 0
Skin
Total: 0
Heart
Total: 0
Lungs
Total: 0
Digestive Tract
Total: 0
Joints and Muscles
Total: 0
Weight
Total: 0
Energy or Activity
Total: 0
Mind
Total: 0
Emotions
Total: 0
Other
Total: 0
Your MSQ Score: 0
<10
Optimal
Maintenance Package Recommended
10-40
Mild
Maintenance Package Recommended
40-100
Moderate
Complete Care Package Recommended
>100
Severe
Complete Care Package Recommended