Dark Skin Patches (Acanthosis Nigricans)

Do you have dark, velvety patches of skin, especially around the neck, underarms, or groin?

Never
Rarely
Sometimes
Often
Always

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Sugar Cravings and Fatigue After Eating

How often do you experience strong sugar cravings, extreme fatigue after meals, or dizziness?

Never
Rarely
Sometimes
Often
Always

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Mood Swings, Anxiety, or Depression

How frequently do you experience mood swings, anxiety, or feelings of depression?

Never
Rarely
Sometimes
Often
Always

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Difficulty Conceiving (If Applicable)

If trying to conceive, how often have you experienced difficulty getting pregnant? (If not applicable, select 1 - Never)

Never
Rarely
Sometimes
Often
Always

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Acne Resistance to Treatment

Have you found that typical acne treatments (creams, washes, medications) do not improve your acne?

Never
Rarely
Sometimes
Often
Always

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Frequency of Hair Fall

How often do you experience excessive hair shedding (losing more than usual when brushing or washing hair)?

Never
Rarely
Sometimes
Often
Always

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Hair Texture Changes

Has your hair become noticeably weaker, brittle, or dry?

Never
Rarely
Sometimes
Often
Always

---

Sideburn or Jawline Hair Growth

Do you experience thick or excessive hair growth on the sideburns or jawline?

Never
Rarely
Sometimes
Often
Always

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Acne and Oily Skin

Do you have persistent acne, oily skin, or frequent breakouts, especially on the lower face?

Never
Rarely
Sometimes
Often
Always

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Difficulty Losing Weight

Do you find it difficult to lose weight even with proper diet and exercise?

Never
Rarely
Sometimes
Often
Always

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Fat Accumulation Around the Waist

Do you notice that most of your weight gain is around your waist or abdomen rather than other areas of your body?

Never
Rarely
Sometimes
Often
Always

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Irregular or Missed Periods

Do you experience irregular or missed menstrual cycles?

Never
Rarely
Sometimes
Often
Always

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