Name: Young Wellness Center
Address: 751 Blossom Hill Rd Suite B, Los Gatos, CA, 95032
Telephone: +1-408-761-6781
Price range: $$$

1. Do you find it difficult to get out of bed?*
- Never
- Occasionally
- Moderately
- Frequently

2. Do you have pain along with fatigue?*
- Never
- Occasionally
- Moderately
- Frequently

3. Are you tired but can’t sleep*
- Never
- Occasionally
- Moderately
- Frequently

4. Do you experience body aches?*
- Never
- Occasionally
- Moderately
- Frequently

5. Have you been hiking and bitten by a tick or suspect a tick bite?*
- No
- Yes

7. Do you have swollen lymph nodes?*
- Never
- Occasionally
- Moderately
- Frequently

9. Do you have bags under your eyes?*
- Never
- Occasionally
- Moderately
- Frequently

10. Have you been experiencing poor memory or mood changes?*
- Never
- Occasionally
- Moderately
- Frequently

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Calculated Score
Your results show that it is “Unlikely” that you may be affected by one of these conditions.
Your results show that it is “likely” that you may be affected by one of these conditions.
Your results show that it is “Highly Likely” that you may be affected by one of these conditions.
Your results show that it is “Almost Positive” that you may be affected by one of these conditions.
Low iron or anemia, vitamin deficiencies, low sex hormones, autoimmune conditions like lupus or rheumatoid arthritis, thyroid problems (like Hashimoto’s), adrenal problems, an infection like Lyme Disease or EBV, allergies or food intolerance.

We recommend further testing to correctly diagnose the condition to then be able to discuss the most appropriate course of treatment.

Book your complimentary consultation and we can discuss the tests we can run based on the information you have provided us.
Name*
Last Name*
Email*
Phone*
Do you want to be contacted regarding this result?*
- Yes
- No
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Chronic Fatigue

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