Mood and Stress Questionnaire - Practitioner Form

Mood and Stress Questionnaire - Practitioner Form

PART 2: PRACTITIONER TO FILL OUT

 

Herbal Formula

Add the scores for each section in Part 1 and enter the total into the ‘score’ column below.

• Rank each section based on the score in descending order (i.e. 1 is the top score, 2 is the second highest, etc).
• Rank 1 indicates the most relevant prescription for your patient.
• If the top scores are close, check the questions relevant to the section and ascertain which is most relevant to your patient.

Section 1 - Adaptan: 

Section 2 - Adrenotone: 

Section 3 - Infla-Mood: 

Section 4 - NeuroCalm: 

Section 5 - Relaxan (females) or AndroLift (males): 

Section 6 - Resilian: 

Section 7 - NeuroCalm Sleep: