Health Assessment

How healthy and energetic do you feel?

 
Disagree ................ Agree
Tired most of the time
1 2 3 4 5
Overweight
1 2 3 4 5
Prone to hormonal symptoms
1 2 3 4 5
Suffering from poor memory and concentration
1 2 3 4 5
Low or depressed
1 2 3 4 5
Plagued by dry skin in need of daily moisturisers
1 2 3 4 5
Having difficulty sleeping
1 2 3 4 5
Often feeling anxious or stressed
1 2 3 4 5
Prone to indigestion or bloating after food
1 2 3 4 5
Often constipated (you rarely go twice a day)
1 2 3 4 5
Suffering from dark circles or bags under your eyes
1 2 3 4 5
TOTAL:
Ideal target: 14 or less

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Disagree ................ Agree
I still feel tired 20 minutes after getting up
1 2 3 4 5
I need tea, coffee or a cigarette, or something sweet to get me going in the morning
1 2 3 4 5
I often crave chocolate, sweet foods, bread, cereal or pasta
1 2 3 4 5
I often have energy slumps during the day or after meals
1 2 3 4 5
I often crave something sweet / coffee after meals
1 2 3 4 5
I often have mood swings or difficulty concentrating
1 2 3 4 5
I get up dizzy or irritable if I go 4 to 6 hours without food
1 2 3 4 5
I often overreact to stress
1 2 3 4 5
I have less energy than I used to
1 2 3 4 5
I often feel too tired to exercise
1 2 3 4 5
I am gaining weight / finding it harder to lose weight
1 2 3 4 5
TOTAL:
Ideal target: 16 or less

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