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Health Status Questionnaire

Instructions

Step 1: Complete all 30 questions as accurately and carefully, as possible. Be totally honest with yourself and your answers. You can either use the Print this Page link below to print the questionnaire on your local printer right from your browser, or just keep a tally of your true and false answers using a pencil and paper as you scroll down through each question.

Printer icon   Print this Page

Step 2: After you complete the questionnaire, determine your score by adding up all of your true and false answers. This is the score you need to determine your actual health status on the home page.

Step 3: Click the link at the bottom of the questionnaire to return to step 2 on the home page, where you can find out your actual health status.


Step 1:  Fill out the Questionnaire

Q1. Are you currently overweight? Overweight is defined as being 10% or more above your set point weight, which was your weight when you were 18 years of age. Obesity is defined as being more than 30% above your set point weight.

True  ______     False   ______                  

Q2. You do not have a good bowel movement in the morning, each and every day, 7 days a week? 

True  ______     False   ______

Q3. You do not prepare all of your meals and snacks at home?

True  ______     False   ______

Q4. You eat more cooked food than raw food?

True  ______     False   ______

Q5. You do not follow the natural, whole foods way of eating, each and every day? Natural, whole foods are live, nutrient-dense foods with most of their vitamins, minerals, enzymes, and antioxidants still intact. 

True  ______     False   ______

Q6. You follow a processed food way of eating, each and every day? Processed foods are mostly dead, nutrient-deficient foods that contain little or no vitamins, minerals, enzymes, and antioxidants. 

True  ______     False   ______

Q7. Do you currently have one or more problems with your digestion and elimination after some or all meals, such as indigestion, stomach pain, heartburn, bloating, belching, gas, constipation, diarrhea, and/or abdominal pain? 

True  ______     False   ______

Q8. Do you drink less than 8 X 8 fluid ounces of pure water, and/or equivalent fluids made with pure water, each and every day? Drinks like coffee, alcohol, soda pop, fruit juices, and energy drinks do not count.  

True  ______     False   ______

Q9. Do you often get headaches and/or migraines?  

True  ______     False   ______

Q10. You do not get 7 to 8 hours of deep, continuous sleep, each and every night, including weekends?  

True  ______     False   ______

Q11. Do you have difficulty falling and staying asleep? I think I am an insomniac.  

True  ______     False   ______

Q12. Is your stress and/or anxiety level often high throughout the day?  

True  ______     False   ______

Q13. You do not reduce the stress that is in your body, so it can become chronic or prolonged, at times?  

True  ______     False   ______

Q14. Do you sit at a desk at the office for up to 8 hours a day, 5 days a week?  

True  ______     False   ______

Q15. Do you sit in a car, bus, or train and commute to and from work each day, for a total of 1 hour or more?  

True  ______     False   ______

Q16. Do you sit and watch television most evenings, for 2 to 3 hours or more?  

True  ______     False   ______

Q17. Are you currently sedentary and/or do not participate in regular physical activities? Sorry, walking the dog doesn't count! 

True  ______     False   ______

Q18. Do you rarely spend time in nature and/or do not get much movement, sunshine, or fresh air in the outdoors?  

True  ______     False   ______

Q19. Do you currently have high blood pressure?  

True  ______     False   ______

Q20. Do you get repeated colds and flus, sinus infections, a stuffy nose, and/or often get sick throughout the year?  

True  ______     False   ______

Q21. Do you often have low energy, lack stamina, and feel fatigued or sluggish a lot of the time?  

True  ______     False   ______

Q22. Are you currently taking one or more prescribed drugs and/or over-the-counter medications?  

True  ______     False   ______

Q23. Do you think you have one or more addictions to and/or cravings for refined sugar, refined white flour products, table salt, processed carbohydrates, caffeine, alcohol, prescribed, and/or over-the-counter drugs.  

True  ______     False   ______

Q24. Do you suffer with a lower back, shoulder, or neck problem/spasm/pain?  

True  ______     False   ______

Q25. Do you currently have pain, stiffness, swelling, inflammation, poor flexibility, and/or lack of mobility while walking, in your knee and/or hip joints, which is manifesting in osteoarthritis of the knees and/or hips?  

True  ______     False   ______

Q26. Do you think you have sarcopenia, which is a loss of muscle mass with age? The loss of muscle mass can manifest as a loss of strength throughout the body with symptoms such as muscle aches, pains, cramping, seizures, and/or twitching.  

True  ______     False   ______

Q27. Do you now have osteopenia, which is a loss of bone mass with age, and a precursor to osteoporosis?  

True  ______     False   ______

Q28. Do you currently feel that you have not found your true purpose in your professional life? What is it I was really meant to do, or to be, in my working world?   

True  ______     False   ______

Q29. Do you currently feel that you have not found your true purpose in your personal, family and/or social life? 

True  ______     False   ______

Q30. Overall, do you feel that your health is quickly slipping away from you? 

True  ______     False   ______


Step 2:  Now, Determine your Score

Add up all of your true and false answers from the questionnaire.

True Answers   _________        False Answers  ________


Step 3:  Next, Return to the Home Page


Go back to: Step 2: Finding Your Actual Health Status




Checkpoint ...

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