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State of Health Self-Assessment Quiz
KEY:
Rarely
Sometimes/Mild
Frequently
All the time
Name
Email
I catch colds, flu, or viral infections
1
2
3
4
None
When I fall sick, recovery takes longer than five days
1
2
3
4
None
I find it difficult to wake up and get out of bed in the morning
1
2
3
4
None
I have dark circles under my eyes
1
2
3
4
None
I feel physically challenged when undergoing stress
1
2
3
4
None
I experience frequent fatigue even after adequate rest
1
2
3
4
None
I have headaches or migraines
1
2
3
4
None
I experience nasal congestion, runny nose, or mucus in the throat
1
2
3
4
None
I have recurring sinus discomfort or pressure
1
2
3
4
None
I experience allergies (dust, pollen, food, skin, etc.)
1
2
3
4
None
I clear my throat frequently
1
2
3
4
None
I have persistent coated tongue, bad breath, body odour and smelly feet
1
2
3
4
None
I have nail fungus, athletes foot, or experience yeast infection
1
2
3
4
None
I experience breathing issues (tight chest, wheezing, shallow breathing, sighing)
1
2
3
4
None
I experience ringing in the ears
1
2
3
4
None
I am told that I grind my teeth and/or snore loudly in my sleep
1
2
3
4
None
I experience bloating, gas and abdominal discomfort
1
2
3
4
None
I experience calf, foot or toe cramps at rest or during sleep
1
2
3
4
None
I experience acid reflux, heartburn, or indigestion
1
2
3
4
None
Certain foods trigger symptoms for me
1
2
3
4
None
I experience motion sickness: sea, car, airplane
1
2
3
4
None
I experience nausea when inhaling second-hand smoke and perfumes
1
2
3
4
None
My bowel movements are irregular or inconsistent
1
2
3
4
None
I experience unexplained body aches or joint stiffness
1
2
3
4
None
My fingers and other joints feel stiff when I wake up in the morning
1
2
3
4
None
My energy levels fluctuate significantly throughout the day
1
2
3
4
None
I struggle with unexplained weight gain or weight loss
1
2
3
4
None
I experience brain fog or difficulty concentrating
1
2
3
4
None
I rely on caffeine, sugar, or stimulants to function
1
2
3
4
None
I experience mood swings, anxiety, or irritability
1
2
3
4
None
I am currently managing one or more chronic health conditions
1
2
3
4
None
I rely on daily medication to manage symptoms
1
2
3
4
None
I require frequent medical appointments or treatments
1
2
3
4
None
My symptoms affect my daily quality of life
1
2
3
4
None
My body feels less able to “bounce back” compared to previous years
1
2
3
4
None
Time's up