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Network for Optimal Aging and Wellness
Located in Watkinsville,Georgia

Phone: 706.769.0720

 
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Emotional:

The Cortisol Evaluation Questionnaire

Associated Medical Conditions:

Yes   No Do you have medically diagnosed depression that has last longer than 6 months?
Yes No Do you have difficult falling asleep and or wake up early?
Yes No Do you suffer from any chronic inflammatory condition (asthma, arthritis, migraines, etc.)?
Yes No Do you have an autoimmune disease (Rheumatoid arthritis, Lupus, Crohns etc)?
Yes No Do you suffer from chronic year-round allergies?
Yes No Have been diagnosed with hypothyroidism or any other thyroid disorder as an adult?
Yes No Do you have elevated cholesterol, blood pressure and or blood glucose?
Yes   No Do you feel anxious, overwhelmed, and easily frustrated about the responsibilities of your life almost on a daily basis?
Yes No Do you experience psychological or emotional conflict in dealing with your spouse, family members, friends, or co-workers almost on a daily basis?
Yes No Do you spend a significant portion of each day in constant worry and fear?

Physical:

Yes No Do you suffer from frequent indigestion, poor elimination (less than 1 bowel movement daily) and or peptic ulcer pain?
Yes No Have you steadily gained weight as you’ve aged and or do you constantly fail at permanent weight loss?
Yes No Are you constantly tired and or experience significant drops in energy as the day wears on?
Yes No Do you exercise less than 30 minutes per session 3 times a week?
Yes No Do you frequently get colds, flus, or cold sores especially following periods of prolonged stress or are finding it takes than longer than usual to recover?
Yes No Do you have recurring or chronic infections?
Yes No Do you have a poor healing wound?
Yes No Do you have adult acne and or oily skin, especially upper body?
Yes No As you get older are finding that you are intolerant to more and more foods and or developed sensitivities to environmental agents, such as food additives (MSG), perfume, cleaning solvents or other work related chemicals?
Yes No Do you suffer from headaches at least once a week?

Social:

Yes No Are you constantly rushing around and or always late for scheduled events?
Yes No Do you have difficulty saying no and often find yourself over committed?

Nutritional:

Yes No Do you crave fatty, salty, and other sweet junk food almost on a daily basis?
Yes No Do you have more than two ounces of alcohol and or 20 ounces of caffeine containing beverages a day?
Yes No Do you skip meals, give yourself less than 20 minutes to eat a meal, and or eat at irregular times on a daily basis?

Scoring:
                     If you answered yes to:

1-6 questions  you may have elevated cortisol levels
7-12 questions very high probability of elevated cortisol
13-25 questions very high risk for accelerated aging and associated diseases or a progression of current Disease State

Now that you suspect that your adrenals may be stressed, how do we prove it?
Click here to find out.

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Revised last: 5/2010