ikecletus013@gmail.com
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Question of
How often do you engage in physical exercise each week?
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5-7 times
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3-4 times
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1-2 times
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Less than once a week
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Never
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Question of
How many servings of fruits and vegetables do you eat daily?
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5 or more
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3-4
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1-2
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Occasionally
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None
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Question of
How much water do you drink daily?
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8 or more glasses
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6-7 glasses
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4-5 glasses
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2-3 glasses
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Less than 2 glasses
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Question of
How many hours of sleep do you get most nights?
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7-9 hours
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6-7 hours
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5-6 hours
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4-5 hours
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Less than 4 hours
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Question of
How often do you smoke tobacco products?
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Never
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Tried once or twice
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Occasionally
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Frequently
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Daily
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Question of
How often do you consume sugary drinks?
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Never
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Once a month
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Once a week
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Several times a week
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Daily
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Question of
When was your last medical checkup?
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Within the last 12 months
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1-2 years ago
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3-4 years ago
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More than 5 years ago
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Never
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Question of
How would you describe your stress level?
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Very low
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Low
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Moderate
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High
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Extremely high
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Question of
How often do you experience headaches?
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Never
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Rarely
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Monthly
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Weekly
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Almost daily
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Question of
How often do you eat fast food?
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Never
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Once a month
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Once a week
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Several times a week
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Daily
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Question of
How would you rate your body weight?
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Ideal for my height
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Slightly above ideal
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Moderately above ideal
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Significantly above ideal
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Extremely underweight or overweight
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Question of
How often do you experience shortness of breath during normal activities?
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Never
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Rarely
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Sometimes
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Often
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Very often
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Question of
How frequently do you consume alcohol?
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Never
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Rarely
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Occasionally
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Weekly
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Daily
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Question of
How often do you check your blood pressure?
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Every 6-12 months
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Every 1-2 years
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Occasionally
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Rarely
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Never
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Question of
How often do you feel energetic throughout the day?
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Always
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Most of the time
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Sometimes
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Rarely
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Never
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Question of
How often do you skip breakfast?
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Never
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Rarely
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Sometimes
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Frequently
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Almost every day
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Question of
Do you have a family history of major illnesses?
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None
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One minor condition
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One major condition
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Multiple conditions
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Unsure
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Question of
How often do you experience digestive problems?
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Never
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Rarely
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Occasionally
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Frequently
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Very frequently
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Question of
How often do you spend time outdoors or in sunlight?
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Daily
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Several times weekly
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Weekly
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Rarely
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Almost never
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Question of
How would you rate your overall health?
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Excellent
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Very Good
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Good
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Fair
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Poor
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