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Dr. Wenying Lin
Paul Murray

 

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Chinese Fertility Diagnosis Questionnaire

Answer yes or no to each of the following questions. Don't worry about what the symptoms mean: just note whether you experience them. If you have more than one-fourth to one-third yes responses in any diagnostic category, then you may have an element of this type of imbalance in your system. You may have more than one kind of imbalance operating at the same time, so don't be surprised if you have 50 percent yes answers for more than one diagnostic category.

Click here to view and print the questionnaire.
Right-click and choose "Save-As" to save the form to your computer.

Please contact us with any questions or to schedule an appointment.

This document is in PDF format. You can download a free reader by clicking the logo below or by visiting http://www.adobe.com/products/acrobat/readstep2.html

 

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