Institute for Functional Medicine · Self-Assessment Instrument
Rate each symptom based on how you have felt over the past 30 days. For a follow-up, rate only the past 48 hours. Your responses generate a personalized functional health action report.
Assessment Details
Rating Scale
0
Never / Almost never
1
Occasionally, not severe
2
Occasionally, severe
3
Frequently, not severe
4
Frequently and severe
0 of 71 answered
✓
Your Report Is Ready
You've completed all 71 symptom ratings. Enter your name and email below to unlock your personalized Functional Health Report — including your IFM domain scorecard, lifestyle action plan, and supplement protocol.
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Your information is used only to send you a copy of your report and for Dr. Bekkum's office to follow up. It is never sold or shared with third parties. HIPAA-compliant handling.