1. Have you been troubled with...(symptoms)...?
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Abdominal colic |
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Stomach pains |
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Coughing |
|
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Headaches |
2. Have you been suffering from....?
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Abdominal pain |
|
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Constipation |
|
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Vomiting |
3. Have you ever had any....?
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Chest pain |
|
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Vomiting |
|
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Blood in the stool |
4. Have you recently noticed any...(symptoms)...?
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Blood in your stools |
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Trouble swallowing |
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Change in bowel habits |
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Lumps in your breasts |
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Loss of weight |
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Fevers |
5. Are you having any...(symptoms)...lately
?
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Trouble with your periods |
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Bleeding between periods |
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Problems with sexual function |
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Crying spells |
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Difficulty urinating |
6. Tell me if you've ever experienced...(symptoms)...?
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Breast pain |
|
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Difficult swallowing |
7. Have you ever had...(symptoms)...in your
chest ?
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Pain |
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Tightness |
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Pressure |
|
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Heaviness |
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Squeezing |
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Burning |
|
