Dr. Schubiner’s List (Adapted)

Welcome to your Dr. Schubiner’s List (Adapted) Do you have the following symptoms? Answer Yes or No

Heartburn/Nausea

Yes No

Abdominal Pains/Bloating

Yes No

Irritable Bowel /Functional Bowel Syndrome

Yes No

Tension Headaches

Yes No

Migraine Headaches

Yes No

Unexplained Rashes

Yes No

Anxiety and/or panic attacks

Yes No

Depression

Yes No

Obsessive-Compulsive Thoughts or Actions

Yes No

Eating Disorders

Yes No

Insomnia

Yes No

Fibromyalgia

Yes No

Back Pain

Yes No

Neck Pain

Yes No

Shoulder Pain

Yes No

Repetitive Stress Injury

Yes No

Carpal Tunnel Syndrome

Yes No

Reflex Sympathetic Dystrophy (you will know if you've been diagnosed with this)

Yes No

Temperomandibular Joint Dysfunction, Pain where jaw connects at the ear area.

Yes No

Chronic Tendonitis

Yes No

Facial Pain

Yes No

Numbness, Tingling Sensations

Yes No

Fatigue or Chronic Fatigue Syndrome

Yes No

Palpitations

Yes No

Chest Pains

Yes No

Hyperventilation

Yes No

Recurring Bladder Symptoms/Interstitial Cystitis/Prostate symptoms

Yes No

Pelvic Pain

Yes No

Muscle Tenderness

Yes No

Postural Orthostatic Hypotension (POTS)

Yes No

Tinnitus

Yes No

Dizziness

Yes No

Post Traumatic Stress Disorder

Yes No

Chronic Sinusitis

Yes No

Multiple food or medicine/drug allergies / sensitivities

Yes No

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Dr. Schubiner’s List (Adapted)

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