Symptomatic Assessment - Short Version

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Symptomatic Assessment

If you cannot get your blood test done. Take a short version of our in depth symptomatic assessment about you and your lifestyle (Original assessment has 127 easy questions)

21Questions

1
Your Name* This field is required.Please tell us your full name
First Name
Last Name
2
Your Email* This field is required.Please let us know your email address so we can send you updates
example@example.com
3
Your Phone Number* This field is required.Please provide your contact number so that our experts can help you.
Please enter a valid phone number.
4
Date of Birth* This field is required.Please tell us your DOB so we can have a better idea about your age range
Date
Month
Day
Year
5
Please enter your HEIGHT (in cms) ex. 177cm *

Please enter your WEIGHT (in kg) ex. 74kg *

Please enter your WAIST CIRCUMFERENCE (in inches) ex. 32inches *
6
Your Profession* This field is required.Let us know what is your work profession, it will help us gauge some variables
Please enter your profession here
7
Current Health Conditions* This field is required.Please tell us about any health conditions that you might be suffering from
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Ok
Ok
8
What symptoms are you experiencing?* This field is required.Tell us about any symptoms that you might have noticed
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Ok
9
Are you on any medications?If Yes, Kindly mention the medication along with the dosages. If No, then you can move to the next question
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Ok
10
What are your Health Goals?* This field is required.What is the level of healing that you aim to achieve for your body
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Ok
11
Are you tired often/most of the time?* This field is required.
YESNO
12
Are you sensitive or intolerant to any food?If Yes, Name all the foods. If No, then you can move to the next question
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Ok
13
Do you need tea, coffee, cigarettes or something sweet to get you going in the morning?* This field is required.
YESNO
14
How much is your Water Consumption throughout the day?* This field is required.In liters
15
Are you a* This field is required.you can select multiple options
Vegetarian
Non Vegetarian
Eggitarian
Vegan
16
Do you take any supplements?If Yes, Name all the supplements. If No, then you can move to the next question
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Ok
17
Do you experience any of the following?* This field is required.Select all that may apply
Gases
Abdominal Bloating
Loose stools/Diarrhoea
Constipation
Heartburn
Acidity
Nausea
Vomiting
Poor appetite
Indigestion
Upset stomach
None
18
Average number of hours you sleep per night* This field is required.
> 10 hours
8-10 hours
6-8 hours
< 6 hours
19
Do you experience frequent urination?* This field is required.
YESNO
20
Are your periods regular or irregular?If this does not apply to you, then you can move to the next question
Regular
Irregular
21
Do bones throughout your entire body ache, feel tender or sore?* This field is required.
YESNO
Should be Empty:

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