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Fibromyalgia Signs and Symptoms Checklist


[   ] Pain (widespread and chronic)
[   ] Sleep disturbances (non-refreshing, non-restorative, awaking frequently)
[   ] Cognitive problems (impaired memory and concentration)
[   ] Fatigue, characterized as a profound loss of energy
[   ] Morning Stiffness
[   ] Headaches
[   ] Digestive disturbances (abdominal pain, bloating, gas)
[   ] Irritable bowel (constipation and/or diarrhea)
[   ] Irritable bladder (frequent and/or painful urination)
[   ] Numbness and tingling in extremities
[   ] Dizziness
[   ] Impaired balance and/or coordination
[   ] Depression
[   ] Anxiety
[   ] Allergies
[   ] Skin sensitivities and rashes
[   ] Alcohol intolerance
[   ] Low basal body temperature (below 97.6)
[   ] Dry eyes and/or mouth
[   ] Vision problems
[   ] Cold Sensitivity
[   ] Heat Sensitivity
[   ] Light Sensitiviy
[   ] Sound Sensitivity
[   ] Odors Sensitivity
[   ] Foods Sensitivity
[   ] Medications Sensitivity

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