PART I
Please list your 5 major health concerns in order of importance:
PART II
Please choose the appropriate number on all questions below. 0 as the least/never to 3 as the most/always.
CATEGORY I
CATEGORY II
CATEGORY III
CATEGORY IV
CATEGORY V
CATEGORY VI
CATEGORY VII
CATEGORY VIII
CATEGORY IX
CATEGORY X
CATEGORY XI
CATEGORY XIII
CATEGORY XIV
CATEGORY XV
CATEGORY XVI
CATEGORY XVII (Males Only)
CATEGORY XVIII (Males Only)
CATEGORY XIX (Menstruating Females Only)
CATEGORY XX (Menopausal Females Only)
PART III
PART IV