Select the symptoms that have been common over the last 6 months:


Page 1 of 5

Mark all the symptoms you have that are related to a Dopamine deficiency:


Mind symptoms: (low dopamine)

Emotion symptoms: (low dopamine)
Body symptoms: (low dopamine)
Craving symptoms: (low dopamine)
Page 2 of 5

Mark all the symptoms you have that are related to a Serotonin deficiency:


Emotion symptoms: (low serotonin)

Body Symptoms: (low Serotonin)
Craving Symptoms: (low Serotonin)
Page 3 of 5



Mark all the symptoms you have that are related to a GABA deficiency:



Mind symptoms: (low GABA)

Emotion Symptoms:  (low GABA)
Body Symptoms:  (low GABA)
Cravings Symptoms: (low GABA)
Page 4 of 5

Mark all the symptoms you have that are related to a Acetylcholine deficiency:


Mind symptoms: (low acetylcholine)

Emotion Symptoms:  (low Acetylcholine)
Body Symptoms:  (low Acetylcholine)
Cravings Symptoms: (low Acetylcholine)
Page 5 of 5

Mark all the symptoms you have that are related to a Endorphin deficiency:


Mind symptoms: (low Endorphins)

Body Symptoms: (low Endorphins)
Cravings Symptoms:  (low endorphins)

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