Dr. Lipschultz & Associates
Please answer the following questions, and our doctors will review your submission and reply with the results!
How often do you have the following symptoms?
0 = Never; 1 = Sometimes; 2 = Often; 3 = Constant
How SEVERE are the following symptoms?
0 = No Problems
1 = Tolerable - not perfect, but not uncomfortable
2 = Uncomfortable - irritating, but does not interfere with my day
3 = Bothersome - irritating and interferes with my day
4 = Intolerable - unable to perform my daily tasks
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