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 High Blood Pressure 
 Low Blood Pressure 
 Irregular Heartbeat 
 Cold Hands or Feet 
 Blood Clots 
 Palpitations 
 Swelling of Hands 
 Swelling of Feet 
 Chest Pain 
 Phlebitis 
 Fainting 
 Lightheadedness 
 
Respiratory  
 Cough 
 Bronchitis 
 Difficulty Breathing 
 Phlegm 
 Coughing Up Blood 
 Pneumonia 
 Asthma 
 Painful Breathing 
 Easily Winded 
 
Gastro‐Intestinal  
 Nausea 
 Constipation 
 Diarrhea 
 Bad Breath 
 Ulcers 
 Abdominal Pain 
 Chronic Laxative Use 
 Vomiting 
 Intestinal Gas 
 Indigestion 
 Rectal Pain 
 Belching 
 Blood in Stools 
 Hemorrhoids 
 
  
Urology  
 Painful Urination 
 Urgency to Urinate 
 Unable to Hold Urine 
 Decrease in Urine Flow 
 Frequent Urination 
 Blood in Urine 
 Cloudy Urine 
 Kidney Stones 
 Frequent Night Urination 
 Pain in Groin Area 
 Sexually Transmitted 
 
Disease 
 
Neuro‐Psychological  
 Seizures 
 Areas of Numbness 
 Concussion 
 Twitches 
 Lack of Coordination 
 Depression 
 Irritability 
 Loss of Balance 
 Stress 
 Poor Memory 
 Anxiety 
 Mood Swings 
 Tremors 
 
 
 
Gynecology  
                   Age of Menses 
 Irregular Periods 
 Clots 
                   Duration of Menses 
 Painful Periods 
 PMS 
                   Date of Last Menses 
 Breast Lumps 
 Menopausal 
                   # of Pregnancies 
 Spotting 
 Yeast Infections 
                   # of Births 
 Vaginal Discharge 
 Fertility Problems 
 
Musculo‐Skeletal  
 Arthritis 
 Muscle Weakness 
 Muscle Cramping 
 Muscle Spasms 
 Scoliosis 
 Weak Joints 
 Pain with Weather 
 Pain with Activity 
 Pain After Waking 
Changes 
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