Instructions for this Toxicity Questionnaire

Read the following questions and rate them based on how you have been feeling in the past 30 days.

Scoring

0 (or leave blank) = No, or never, or almost never occurs

1 = Occasionally occurs, effect is not severe

2 = Occasionally occurs, effect is severe

3 = Frequently occurs, effect is not severe

Step 1 of 7

  • This short questionnaire is solely for patient self-knowledge. You will not be asked to enter any personal information to view your results. If you are interested in learning more, or would like to have access to additional questionnaires, schedule a complementary consultation today.

  • Liver

  • Gastrointestinal

This questionnaire was developed by Systemic Formulas, Inc. The questionnaire is not intended to be used to diagnose any disease or as a basis for prescribing for any disease. It is solely for clinician insight and patient self-knowledge. If you are interested in learning more, or would like to have access to additional questionnaires, schedule a complementary consultation today.