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5

Vegan or vegetarian diet

No/never A little/rarely Moderately/sometimes Significantly/often Very much/always

4

Evening fatigue

No/never A little/rarely Moderately/sometimes Significantly/often Very much/always

3

Diffuse hair loss (hair falls out evenly across the entire surface of the head)

No/never A little/rarely Moderately/sometimes Significantly/often Very much/always

2

Pale face, paleness of the skin

No/never A little/rarely Moderately/sometimes Significantly/often Very much/always

1

Brittle nails

No/never A little/rarely Moderately/sometimes Significantly/often Very much/always