Vitamins, Minerals & Nutrients p. 2

Rate the frequency of the following symptoms.

Rate how often you experience the symptoms listed.

Rate the frequency of each symptom. Choose the appropriate option:

Indicate how often you experience the listed conditions or habits.

Indicate how often you experience the listed conditions or habits.

Indicate how often you experience the listed conditions or habits.

Indicate how often you experience the following symptoms.

Indicate how often you experience the following symptoms.

Indicate how often you experience the symptoms listed.

Please select how often you experience the listed symptoms.

Select how often you experience the listed symptoms and habits.

Questionnaire based on Dr. Ertog's method for assessing the likelihood of vitamin B1 deficiency.