Mental Health Thermometer

1
Which Country you Live In* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Australia
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
2
Which city do you live in* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Name* This field is required.
First Name
Last Name
4
Email* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
5
Date of Birth* This field is required.
dd-mm-yyyy
Day
Month
Year
6
Gender* This field is required.
Male
Female
Non-Binary
7
Blood Group* This field is required.
A+
A-
B+
B-
AB+
AB-
O+
O-
Bombay Blood Type
8
Activity Level* This field is required.
Little To No Exercise
Light Exercise (1-3 days/week)
Moderate Exercise (3-5 days/week)
Heavy Exercise (6-7 days/week)
9
What type of diet do you take?* This field is required.
Vegan
Veg
Veg+Eggs
Low on Non-Veg ( Once a week)
Medium on Non-Veg ( At least 2-3 times a week)
High on Non-Veg ( At least 5 times a week)
10
What is your resting heart rate* This field is required.(Measuring your heart rate after deep breathing & resting for 5-10 minutes)
11
What is your SPo2 level?* This field is required.
12
Your Height (Cms)* This field is required.
13
Your Weight (Kgs)* This field is required.
14
A - Have you been bothered by getting angry frequently?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
15
B - Have you been bothered by one or multiple of these?* This field is required.
Depressed
Anxiety
Panic attacks
Hopeless about present or future
Irritability
None
16
C - Have you observed extreme weight loss or weight gain in the recent past?* This field is required.
Yes
No
17
D - Have you been bothered by loss of interest in things you normally enjoyed doing?* This field is required.
Yes
No
18
E - Often have feelings of being tired or having little energy?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
19
F - Had trouble falling or staying asleep, or sleeping too much?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
20
G - Have poor appetite or land up overeating?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
21
H - Have you experienced unexplained body aches and pains (they aren't because of an accident or exercise)?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
22
I - For how many hours daily do you use Digital Devices (Computer & Mobile Phone)?* This field is required.
Less than 4
4-6
6-8
greater than 8
23
J - Is anyone of these causing you stress?* This field is required.
Financial
Relationship
Abused
Not treated well
Stress in the job
Stress of loosing the job
None
24
K - Have you gone through in the past or at present going through any one of them?* This field is required.
Emotional Trauma
Physical Trauma
Both
None
25
L - Do you have any one of these emotions taking over at times?* This field is required.
Fear
Insecurity
Worry
Low self esteem
Jealousy
Grief
None
26
M - Where you scared for yourself or for your near & dear ones health & well being covid?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
27
N - Do you have any family history of Mental Health Issues?* This field is required.
Yes
No
28
O- How many hours on an average do you sleep daily?* This field is required.
Less than 4
4-5
5-6
6-7
7-8
Greater than 8
29
P - How many liters of water you drink daily* This field is required.
Less than 1
1-2
2-3
3-4
4-5
Greater than 5
30
Q - How many years back you got yourself dewormed?* This field is required.
Less than 1
1
2
3
Greater than 3
Never
31
R - Do you have tingling or numbness or pain in your tongue or have frequent mouth ulcers that last more than two weeks?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
32
S - What is the closest tongue image below your tongue resembles to?* This field is required.
No Groove
Low Groove
Medium Groove
Deep Groove
33
T - Look at the ear lobe and what is the closest ear lobe image below your ear lobe resembles to?* This field is required.
No Groove
Low Groove
Medium Groove
Deep Groove
34
U - Do you have dark circles around your eyes?* This field is required.
Yes
No
35
V - Do you have frequent Neck pain, Muscle Spasms/Fatigue or numbness in arms or hands* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
36
W - Do you have frequent Headaches, Stomachaches?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
37
X - Do you have problem in building & maintaining relationships?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
38
Y - Do you like Social Isolation (Don't like to connect with people)?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
39
Z - Do you feel lonely without being socially isolated?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
40
ZA - Do You have Concentration problems or Memory issues (forgetfulness, etc.) ?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
41
ZB - Do you have problem in decision making?* This field is required.
Not at all
Sometime
Most of the time
Almost all the time
42
ZC - Do you see increase in your symptoms Post Covid?* This field is required.
Yes
No
43
ZD- Did you loose any near & dear ones during covid?* This field is required.
Yes
No
44
ZE - Do you have any know addictions?* This field is required.
Yes
No
45
ZF - How many times did you get infected with Covid/Omicron Infection?* This field is required.
None
1 time
2 times
3 times
> 3 times
46
ZG - Which Covid vaccine shot(s) did you take?* This field is required.
Covishield
Pfizer
Covaccine
Sputnik
Multiple
Not applicable
Other
47
ZH - Are you currently undergoing any treatment?
Life-threatening (Cancer, heart disease, kidney, stroke, liver, lung)
Debilitating (Arthritis, Alzheimer's disease, Parkinson's disease)
Chronic and progressive (Diabetes, multiple sclerosis, HIV/AIDS)
Self-limiting (Common cold, flu, stomach virus)
Mild to moderate symptoms (Allergies, headaches, minor injuries)
Low risk of complications (Pink eye, ear infections, urinary tract infections)
All of the above
None of the above
48
ZI - How happy & satisfied life are you living?
1
2
3
4
5
Not very happy & satisfied
Very happy & satisfied
49
This test is just an indication of your Mental Health and should not be considered as an alternative to conventional diagnostic assessment* This field is required.
I Agree
50
My Products* This field is required.
prevnext( X )
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costAUD
Mental Health ThermometerMental Health Thermometer
$15.00AUDEdit
Back
1
1
2
3
4
5
6
7
8
9
10
Quantity
Enter Coupon
Total cost $0.00AUD
Payment Methods
Credit Card
First Name
Last Name
Google Pay
After submitting the form, you will be redirected to the Google Pay to complete the payment process.
Apple Pay
After submitting the form, you will be redirected to the Apple Pay to complete the payment.
51
Invoice ID
Should be Empty: