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    Consultation Card

    Indicate on a scale of 0 to 10 how much trouble you have.

    0 = no trouble
    10 = a lot of trouble

    Fatigue
    Eyes
    Nose
    Mouth · throat · esophagus
    Lungs
    Abdomen · stomach · pancreas · intestines · liver
    Skin · Raynaud's phenomenon · vasculitis
    Bladder
    Vagina or prostate
    Muscles · joints
    Neurological complaints · neuropathy
    40 characters remaining
    Other complaints
    Consultation Card