Mood & Neurotransmitter Questionnaire (including Pyrolurea)

PLEASE NOTE: Please do not fill this in unless asked by your practitioner. Results will be reviewed together and treatment plan established in your next appointment. Thank you. 

This questionnaire is utilised to ascertain current levels and/or deficiencies of certain neurotransmitters and essential co-factors for optimal brain function and mood. Please fill this out if Angela Busby has indicated for you to complete this, click submit once you are finished and we will review your results before your next appointment.

Please allocate roughly 15 minutes to complete. 

Name *
Name
GABA:
Please check the boxes that apply to you:
SEROTONIN:
Please check the boxes that apply to you:
CATECHOLAMINES:
Please check the boxes that apply to you:
ENDORPHINS:
Please check the boxes that apply to you:
PYROLUREA:
Please check the boxes that apply to you:
PYROLUREA (less common signs & symptoms):
Please check the boxes that apply to you: