Herbal Use Survey

Herbal Use Survey

Which of the following do you most often use herbal supplements?

	Skin conditions
	Thyroid
	Headache
	Other chronic pain
	Mood (depression/anxiety)
	Menopause
	Infections
	Diabetes
	Cancer
	Sexual dysfunction

What is your second most common use?

	Skin conditions
	Thyroid
	Headache
	Other chronic pain
	Mood (depression/anxiety)
	Menopause
	Infections
	Diabetes
	Cancer
	Sexual dysfunction

Which of the following describes your herbal use for above conditions?

	I only take herbs alone.
	I take herbs with prescription medications.
	I combine herbs with prescriptions and lifestyle changes such as exercise and diet.
	I don't use herbs yet, but might in the future.

Do you take herbs daily or only as needed?

	Daily for long term benefit.
	No, only short term, as needed for certain conditions.

Do you think herbs have helped your conditions?

	Yes.
	No.

Please enter the word that you see below.

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