Energy level – at what time of day is it……
Dry. Itchy. Moist / clammy. Burning . Changing moles or lumps (cysts / tumors) Boils. Frequent skin rashes. Acne. Hair loss / thinning. Dry scalp. Puffy or wrinkled skin. Hives. Other _____ Sleep . Trouble falling asleep. Trouble staying asleep. Usually restful. Excess or vivid dreaming. Average number of hours per night = _____ Head . Dizziness ................
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