THYROID SYMPTOMS SURVEY                                                                                                                                                                                                                                              
Dr. T's Core Hormones "TM"  


Periodically over the course of your treatment you will be asked to retake this questionnaire. This provides your thyroid doctor important data to evaluate changes in your thyroid symptoms and gauge progress over time.

Regards,

The Nitek Medical Team

Sign in to Google to save your progress. Learn more
Email *
Patient Name *
Captionless Image
Sex *
Captionless Image
Date Of Birth *
Captionless Image
MM
/
DD
/
YYYY
Height, Please state Inches or Cm
Captionless Image
Weight, please state lbs. or Kg *
Captionless Image
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy