Body Type for Weight LossDo you have any of the following symptoms"*" indicates required fieldsStep 1 of 166%General InformationThis survey takes approximately 2 minutes to complete. Thank you for your participation!Email*Name*FirstLastSwelling of the face or eyelids in the morning, or feeling of swelling when pressing on feet or between finger*Once a week or moreNoIn the morning, can see a white and sticky tongue coating or feeling of phlegm blocking the throat.*Once a week or moreNoThe stool is wet and sticky, easily adhering to the toilet.*Two times a week or moreNoThis field is hidden when viewing the formWeak Digestive SystemFear of heat, mouth easily cracks, face is oily, and prone to acne.*Has at least one symptomNoEasily experiences bitterness in the mouth, or dryness and parched tongue, or has bad breath.*Has at least one symptomNoLarge appetite, or easily hungry, or eats too quickly (finish a full meal like dinner in less than 20 minutes)*Has at least one symptomNoThis field is hidden when viewing the formProne to Inflammatory ResponsesThe complexion appears dull or pale yellow, has freckles, light brown, dark brown, dot-like or patch-like spots*Has at least one symptomNoOften stays up late pass 11 pm or lies in bed for more than thirty minutes before being able to fall asleep.*Two times a week or moreNoOften experiences at least five of following symptoms:*IrritabilityEasy AngerAnxietyInsomniaFrequent DreamsEasy AwakeningEye FatigueDrynessDiscomfortHeadacheDizzinessMigraineFrequent UrinationLack Of Sexual DriveLack Of ConcentrationTinnitusDecline In MemoryAbdominal BloatingOften Constipated Or DiarrhoeaExcessive Stomach Acid Or Gastroesophageal RefluxStiffness And Soreness In Shoulders And NeckPalpitationsChest TightnessDifficulty Breathing SmoothlyHigh Blood Pressure Or Fluctuating GreatlyExcessive Sweating Or Lack Of SweatingNoneThis field is hidden when viewing the formProne to StressThe complexion is rather pale, or the nails and lips are pale in color, lacking in vitality or have anemia.*Has at least one symptomNoPoor blood circulation, easily experiencing cold hands and feet, or feeling very cold.*Has at least one symptomNoEasily feeling tired, fatigued and weak*YesNoThis field is hidden when viewing the formWeak Qi and BloodFeeling sensations of swelling in the lower body*YesNoEasily catches a cold (more than two times per year). Or has an allergic constitution, such as allergic dermatitis, asthma.*YesNoFrequent urination, more than two times in the night time, urine is clear with no obvious odor.*YesNoThis field is hidden when viewing the formProne to Water Retention
