One Minute Health Check – B12 Deficiency signs and symptoms
A quick survey will reveal if B12 deficiency, underactive thyroid or iron deficiency anaemia are possible diagnoses, and if the physician should order further tests.

Upon completion your survey will be sent to Dr Andrew Klein for review and you will receive a response within 24-72 hours. Should you have had a blood test recently, Dr Klein will also ask you to provide those results.

Please answer the questions within this survey by selecting Yes or No. Please skip questions which are not relevant.

Please enter your name*

Please enter your name*

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Please enter your date of birth*

Please enter your date of birth*

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Have you had blood tests*

Have you had blood tests*

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Please enter your email*

Please enter your email*

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Please enter your phone number*

Please enter your phone number*

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Please enter your address*

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Please enter your GP details*

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Energy/ haemopoetic

Weariness, Lethargy, tiredness, fatigue

Weariness, Lethargy, tiredness, fatigue

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Disturbed sleep

Disturbed sleep

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Nervous system

Tremor

Tremor

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Loss of balance (ataxia), falls

Loss of balance (ataxia), falls

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Tingling or numbness in hands and/or feet, burning sensation

Tingling or numbness in hands and/or feet, burning sensation

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Restless leg syndrome

Restless leg syndrome

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Dizziness

Dizziness

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Pain in limbs

Pain in limbs

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Stiffness of limbs

Stiffness of limbs

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Weakness in limbs

Weakness in limbs

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Migrainous headache

Migrainous headache

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Psychiatric

Irritable, snappy

Irritable, snappy

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Confused, memory disturbance/ forgetful, fogginess (brain fog)

Confused, memory disturbance/ forgetful, fogginess (brain fog)

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Headaches, migraine

Headaches, migraine

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Mood swings, Anxiety/Panic Attacks

Mood swings, Anxiety/Panic Attacks

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Depression

Depression

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Eye Ear Throat

Blurred vision/double vision

Blurred vision/double vision

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Tinnitus

Tinnitus

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Difficulty swallowing, persistent cough

Difficulty swallowing, persistent cough

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Immune System

Prone to recurrent UTI

Prone to recurrent UTI

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Frequent cough/cold

Frequent cough/cold

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Cardiovascular/Respiratory

Shortness of breath

Shortness of breath

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Palpitations, chest pain

Palpitations, chest pain

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Pallor, lemon yellow complexion

Pallor, lemon yellow complexion

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Bruising

Bruising

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Gastro-Intestinal (GI)

Sore tongue, bleeding gums

Sore tongue, bleeding gums

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Mouth/tongue ulcers

Mouth/tongue ulcers

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Cracking the angles of mouth

Cracking the angles of mouth

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Loss of appetite, loss of weight

Loss of appetite, loss of weight

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Gastric symptoms-acidity, heartburn

Gastric symptoms-acidity, heartburn

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Intermittent diarrhoea, IBS, constipation

Intermittent diarrhoea, IBS, constipation

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Skin hair nail skeletal

Premature greying

Premature greying

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Alopecia, Unexplained hair loss

Alopecia, Unexplained hair loss

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Joint inflammation, swelling, pain

Joint inflammation, swelling, pain

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Dry skin, brittle nails

Dry skin, brittle nails

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Genito-Urinary (GU)

Heavy painful periods, irregular periods

Heavy painful periods, irregular periods

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Loss of libido

Loss of libido

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Incontinence

Incontinence

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Personal & Family History

Family history of B12 deficiency (Pernicious Anaemia)

Family history of B12 deficiency (Pernicious Anaemia)

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Vegetarian, vegan

Vegetarian, vegan

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