Dr Amy Myers

Health Assessment  ·  Dr. Amy Myers MD

The Autoimmune Solution™
Symptom Tracker

Rate your symptoms over the past 7 days  ·  Takes about 3 minutes

Step 1 of 5 0%
🧠

Head, Mind & Eyes

Rate each symptom  ·  0 = None   1 = Some   2 = Mild   3 = Moderate   4 = Severe
Symptom01234
HEAD
Headaches
Migraines
Faintness
Trouble sleeping
MIND
Brain fog
Poor memory
Impaired coordination
Difficulty deciding
Slurred/stuttered speech
Learning/attention deficit
EYES
Swollen, red eyelids
Dark circles
Puffy eyes
Poor vision
Watery, itchy eyes
🫁

Nose, Ears, Mouth & Chest

Rate each symptom  ·  0 = None   1 = Some   2 = Mild   3 = Moderate   4 = Severe
Symptom01234
NOSE
Nasal congestion
Excessive mucus
Stuffy/runny nose
Sinus problems
Frequent sneezing
EARS
Itchy ears
Earaches, infections
Drainage from ear
Ringing, hearing loss
MOUTH / THROAT
Chronic cough
Clear throat frequently
Sore throat
Swollen lips
Canker sores
HEART
Irregular heartbeat
Fast heart rate
Chest pain
LUNGS
Chest congestion
Asthma, bronchitis
Shortness of breath
Difficulty breathing
🌿

Body, Digestion & Mood

Rate each symptom  ·  0 = None   1 = Some   2 = Mild   3 = Moderate   4 = Severe
Symptom01234
SKIN
Acne
Hives, eczema, dry skin
Hair loss
Hot flashes
Excessive sweating
WEIGHT
Inability to lose weight
Food cravings
Overweight
Underweight
Compulsive eating
Water retention/swelling
DIGESTION
Nausea/vomiting
Diarrhea
Constipation
Bloating
Belching/passing gas
Heartburn/indigestion
Intestinal/stomach pain or cramps
EMOTIONS
Anxiety
Depression
Mood swings
Nervousness
Easily irritated
ENERGY / ACTIVITY
Fatigue
Lethargy
Hyperactivity
Restlessness
JOINTS / MUSCLES
Pain/aching joints
Arthritis
Muscle stiffness
Pain/muscle aches
Weakness/tiredness
OTHER
Frequent illness/infections
Frequent/urgent urination
Genital itch, discharge
Anal itch
📋

Additional Health Questions

Answer yes or no — these adjust your final score

Have you been diagnosed with an autoimmune condition and currently have symptoms?

➕ +80 points if yes

Do you have more than one autoimmune disease and currently have symptoms?

➕ +100 points if yes

Do you have elevated inflammatory markers such as ESR, CRP, or homocysteine?

➕ +10 points if yes

Do you have any diagnosis ending with "itis" — such as arthritis, colitis, pancreatitis, sinusitis, or diverticulitis?

➕ +10 points if yes
👨‍👩‍👧

Family History & Demographics

A few final questions about your family health background

Do you have a first-degree relative (parent or sibling) with an autoimmune disease?

➕ +10 points for the first relative, +2 for each additional
How many first-degree relatives?

Do you have a second-degree relative (grandparent, aunt, or uncle) with an autoimmune disease?

➕ +5 points if yes

Are you female?

➕ +5 points if yes

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