Health Check



Your Name (required)

1) Do you consider yourself to be?
 A. Shy B. Introverted C. Outgoing party D. Life and soul of the party

2) In your leisure time?
 A. Active B. Do an exercise class at least once a week C. Don’t get time for any exercise classes D. Don’t like exercising

3) Is your life style?
 A. Stressful at the moment but normally OK B. Always stressful C. Has been very stressful in the past but is presently ok D. Not stressful

4) Do you suffer with headaches?
 A. Regularly B. Sometimes C. Never D. Only self inflicted – through alcohol or dehydration

5) Body shape?
 A. Normal B. Overweight but can’t lose anything despite dieting C. Too thin despite eating loads D. Ok but feel bloated all the time

6) How is your mood?
 A. Happy most of the time B. Low most of the time C. Up and down all the time D. Nervous/anxious

7) Do you suffer with?
 A. Recurring minor illness’ e.g sore throats? B. IBS/ bowel problems C. Circulation problems cold hands/feet D. Swelling of joints

8) How is your energy level?
 A) I have energy when i awake, but it diminshes as the day goes on B) My energy has depleted – it's because I'm getting older … isn't it?. C) I have very low energy levels. everything seems to be an effort D) No problems. Always got loads of energy.

9) About your diet
 A) Mainly carbohydrates e.g. bread, cereals, potatoes, fast/convenience foods B) I am a vegetarian (only eat fish) C) I am a vegan D) I have a healthy balanced diet

10) How are your calves?
 A) Tend to be on the large side (blend from calf to ankle) B) Tight and swollen C) Always seem to get cramp nowadays D) I don’t have any problems (that I know of)

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