Fibromyalgia Check List - FaceLift Without Surgery
| |Fibromyalgia Check List | | | | |
|Make a check mark by all the symptoms that you have | | |
|Symptoms |Today |Week |Week |Week | Week |
| | |1 |2 |3 |4 |
|Allergies | | | | | |
|Anxieties | | | | | |
|Bruising | | | | | |
|Burning Pain in Feet | | | | | |
|Carpal Tunnel Syndrome | | | | | |
|Chest Pain | | | | | |
|Chronic Fatigue | | | | | |
|Chronic Headaches (Migraine) | | | | | |
|Chronic Muscle Pain | | | | | |
|Clumsiness | | | | | |
|Confusion | | | | | |
|Coordination Impaired | | | | | |
|Depression | | | | | |
|Dizziness | | | | | |
|Dropping Things | | | | | |
|Dry Eyes & Mouth | | | | | |
|Extremity(ies) "Going to Sleep" | | | | | |
|Eye Prescription Changes | | | | | |
|Feeling of Swelling | | | | | |
|Fluid Retention | | | | | |
|Hair Loss | | | | | |
|High or Low Temperatures | | | | | |
|"Hot Spots" in Muscles | | | | | |
|Insomnia | | | | | |
|Irritability | | | | | |
|Irritable Bowel Syndrome | | | | | |
|Joint Pain (Arthritis) | | | | | |
|Lack of Endurance | | | | | |
|Low Back Pain | | | | | |
|Mental Fogginess | | | | | |
|Symptoms |Today |Week 1 |Week 2 |Week 3 |Week 4 |
|Memory Blanks | | | | | |
|Mood Swings | | | | | |
|Mouth Sores | | | | | |
|Muscle Spasms | | | | | |
|Muscular Jerking at Night | | | | | |
|Numbness.Tingling in Hands/Feet | | | | | |
|Pain Attacks | | | | | |
|Premenstrual Syndrome (PMS) | | | | | |
|Restless Leg Syndrome | | | | | |
|Sensitivity to Environment | | | | | |
|Short-term Memory Loss | | | | | |
|Skin Itch, Mottling, Rash | | | | | |
|Skin Sensitivities | | | | | |
|Sleep Throat | | | | | |
|Stiffness | | | | | |
|Swollen Glands | | | | | |
|Tender Lymph Nodes | | | | | |
|Tender Trigger Points (up to 18) | | | | | |
|TMJ-like Symptoms | | | | | |
|Trouble Concentrating | | | | | |
|Using Wrong Words | | | | | |
|Losing Words | | | | | |
|Vision Changes & Eye Pain | | | | | |
|Weight Gain or Loss | | | | | |
|Other | | | | | |
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