Wellness Risk Assessment
Whats this? Based on decades of research gold indexes have crafted by the medical and science community for triage and first line patient assessment. Supported by AI we have consolidate research outcomes into a 10 minute questioniare the outcome being a wellness rating across multiple risks. From your wellness dashboard, you will be using the assessment results to prioritise the engagement and improvement stages where you will discover an holistic set of AI powered Apps designed to help you improve your risks and stay to stay well. Â
User ID Safety Check
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Please copy userid at top of page so we know you are real.
First Name
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Last Name
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Email
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example@example.com
Gender at Birth
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Please Select
Male
Female
Age
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Ethnicity
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Please Select
White Caucasian
Black Afro Carab
Asian
Other
Weight in kilograms
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Measured in Kilograms
Height in centimeters
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Measured in centimeters
BMI Score
BMI Status
Waist Circumference in centimeters
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Measured as 2 inches below belly button
Neck Circumference in centimeters
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Measured as your collard size with button secured
Thigh circumference in cms
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Measured as thickest part of your thigh
Is Your Blood Pressure High?
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Please Select
Yes
No
BMR Miflin
VFA Score
VFA Status
Any parent, sibling or child have diabetes?
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Please Select
Yes
No
Diabetes Age Score
Diabetes Gender Score
Diabetes Ethnicity Score
Diabetes Family Score
Diabetes Waist Score
Diabetes BMI Score
Diabetes BP Score
Diabetes Score
Diabetes Status
How Often In last 2 Weeks Feeling Nervous, Anxious or on Edge?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
How Often In last 2 Weeks Unable To Stop Or Control Worrying?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
How Often In last 2 Weeks Worrying To Much About Different Things?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
How Often In last 2 Weeks Trouble Relaxing?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
How Often In last 2 Weeks So Restless Its Hard To Sit Still?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
How Often In last 2 Weeks Easily Annoyed or Irritable?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
How Often In last 2 Weeks Afraid Something Awful Might Happen?
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Please Select
Not At All
Several Days
Over Half the Days
Nearly Every Day
GAD Score
GAD Status
Hours Asleep Last Night
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Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Hours In Bed Last Night?
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Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Do you snore loudly
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Please Select
Yes
No
Louder than talking or loud enough to be heard through closed doors
Do you often feel tired?
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Please Select
Yes
No
Feeling fatigued or sleepy during the day
Have you stopped breathing during sleep?
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Please Select
Yes
No
For even short periods has anyone or you noticed you stop breathing during sleep?
OSA Neck Score
OSA Gender Score
OSA Age Score
OSA BMI Score
OSA Score
OSA Status
Difficulty Falling Asleep
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Please Select
No Problem
Mild Problem
Moderate Problem
Severe Problem
Very Severe Problem
Select How Difficult You Find It to Fall Asleep in the last 2 weeks
Difficulty Staying Asleep?
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Please Select
No Problem
Mild Problem
Moderate Problem
Severe Problem
Very Severe Problem
Select How Difficult It Is To Stay Asleep After Dropping Off in the last 2 weeks
Problems Waking Up Too early?
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Please Select
No Problem
Mild Problem
Moderate Problem
Severe Problem
Very Severe Problem
Select How Problematic Waking Up Early Is To You in the last 2 weeks
How Satisfied Are You With Your Current Sleep Pattern?
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Please Select
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Select How Satisfied Your Feel With How Many Hours Sleep You Get Compared to Time In Bed
How Noticeable to Others Do You Think Your Sleep Problem Is?
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Please Select
Not at all
Noticeable A Little
Somewhat Noticeable
Much Noticeable
Very Much Noticeable
The Degree To Which Poor Sleep Is Impairing The Quality of Your Life in The Eyes of Other People
How Worried Are You About Your Current Sleep Problem?
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Please Select
Not at all
A Little Worried
Somewhat Worried
Much Worried
Very Much Worried
How Much Does Your Sleep Problem Interfere With Daily Functioning?
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Please Select
Not at all
Interferes A Little
Interferes Somewhat
Much Interference
Very Much Interference
For Example: Daytime Fatigue, Mood, Ability To Function At Work/Chores, Concentration, Memory
Insomnia Index Score
Insomnia Status
Difficulty Falling Asleep at Desired Bedtime: Circadian 1
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Please Select
Rarely or never have trouble falling asleep at my desired bedtime.
Occasionally have trouble (1-2 times per week).
Frequently have trouble (3-5 times per week).
Almost always have trouble (6-7 times per week).
The main aspect of this question is going to sleep at the desired time
Difficulty Waking Up at Desired Wake-Up Time?
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Please Select
Rarely or never have trouble waking up at my desired time.
Occasionally have trouble (1-2 times per week).
Frequently have trouble (3-5 times per week).
Almost always have trouble (6-7 times per week)
The main aspect of this question is waking at the desired time
Feeling Alert/Energetic at Inconvenient Times?
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Please Select
Rarely or never feel most alert at inconvenient times.
Occasionally feel more alert at inconvenient times (1-2 times per week).
Frequently feel more alert at inconvenient times (3-5 times per week).
Almost always feel more alert at inconvenient times (6-7 times per week)
Refers to tbeing most awake during times when it's not ideal for your daily routine. Times when you should be asleep
"Night Owl" or "Early Bird"
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Please Select
Strongly identify as an early bird and it aligns with my schedule.
Mildly identify as an early bird but struggle to maintain this on weekends.
Mildly identify as a night owl but can function reasonably well on a daytime schedule.
Strongly identify as a night owl and struggle significantly with daytime schedules.
What would friends or family say you are?
Social Jetlag (Difference in Sleep Schedule Weekdays vs. Weekends)?
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Please Select
Less than 1 hour difference in sleep times between weekdays and weekends.
1-2 hours difference.
2-3 hours difference.
More than 3 hours difference.
Social jetlag measures how much your sleep schedule is dictated by social demands (work, school) versus your body's natural biological clock.
Screen Use Before Bed (Within 1 Hour of Sleep Time)?
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Please Select
Rarely or never use screens before bed.
Sometimes use screens (1-3 times per week).
Frequently use screens (4-6 times per week).
Almost always use screens before bed (7 times per week).
Amount of Daytime Light Exposure?
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Please Select
Spend a significant amount of time outdoors in natural light daily.
Spend some time outdoors in natural light most days.
Mostly indoors, limited exposure to natural light.
Almost entirely indoors, very little to no natural light exposure
how much natural sunlight during waking hours each day. Ie exposure to outdoor light, not artificial indoor light
Circadian Rhythm Score-need to check the algorithm is logical
Circadian Rhythm Status
Rate the severity of any abdominal pain you maybe experiencing? (SSS1)
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Please Select
No abdominal pain
Mild abdominal pain
Moderate abdominal pain
Severe abdominal pain
SSS1 on the Rome Scale
Rate the frequency of any abdominal pain you maybe experiencing? (SSS2)
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Please Select
Rare or Never
Occasional
Often
Nearly Always or Always
SSS2 on the Rome Scale
Do you experience bloating or gas in your abdomen (SSS3)?
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Please Select
No
Occasional
Frequently
Permnanently. Almost constant
SSS3 on the Rome Scale
How often do you experience diarrhea or constipation or a cycle of both (SSS4)?
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Please Select
Never or rarely
Occasionally (1-3 days a week)
Often (4-6 days a week)
Almost always or always
SSS4 on the Rome Scale
Do bowel and abdomin problems affect your daily life? (SSS5)
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Please Select
Never or rarely
Occasionally (1-3 days a week)
Often (4-6 days a week)
Almost always or always
Affect on such as work, social activities, or relationships. SSS5 on the Rome Scale
Does any stomach pain get better after a bowel movement?
Please Select
No
Sometimes
Yes
Don't Know
Do you have changes in stool form (hard/lumpy or loose/watery) when you have stomach pain?
Please Select
No
Yes, harder/lumpier
Yes, looser/watery
Yes, alternating
Don't Know
How often do you feel like you still need to go after a bowel movement?
Please Select
Rarely or Never
Occasionally
Often
Almost Always
Don't Know
Do you have a family history of IBS or gastrointestinal disorders?
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Please Select
No
Yes
Dont Know
Not on the IBS SSS Scale
Your level of Anxiety (auto-based on GAD Status)?
Not on SSS Scale (low gad=0, severe gad=10 etc)
IBS Score
IBS Status
SIBO1:Does bloating get worse after eating carbohydrates?
Please Select
No
Sometimes
Yes, significantly worse
Don't Know
Do you have a history of chronic antibiotic use?
Please Select
No
Yes, once in past year
Yes, multiple times/chronic
Don't Know
Do you frequently experience motality issues eg indigestion, bloating, feeling full quickly, nausea, constipation,
Please Select
No
Yes, suspected
Yes, diagnosed
Don't Know
Have you taken PPI for an extended period (more than 1 month)
Please Select
No
Yes, in the past
Yes, currently
Don't Know
What has been the impact of Antibiotics on your motality issues?
Please Select
Not taken antibiotics
Motality worsened
Motality stayed the same
Motality improved
Don't Know
SIBO Score
SIBO Status
Celiac 1-Do you have iron-deficiency anemia, even though you get enough iron?
Please Select
No
Yes, in the past
Yes, currently
Don't Know
Have you been diagnosed with osteoporosis or osteopenia before age 50?
Please Select
No
Yes, suspected
Yes, diagnosed
Don't Know
Family history of celiac disease, autoimmune disorders, or other digestive conditions?
Please Select
No
Yes, one 1st-degree relative
Yes, multiple 1st-degree relatives
Don't Know
Do you have or ever had, an itchy rash with blistering on your joints or torso for more than a few weeks?"
Please Select
No
Yes, suspected
Yes, diagnosed
Don't Know
Have you tried a gluten-free diet that improved stomach problems
Please Select
Not tried
No improvement
Slight improvement
Significant improvement
Don't Know
Celiac Score Numeric
Celiac Status
lactose1-Do you regularly experience gas, bloating or diarreah after consuming dairy products (like milk, cheese, and yogurt)?"
Please Select
No
Sometimes
Yes
Don't Know
Have you tried a dairy-free diet and it improved gastro problems?
Please Select
Not tried
No improvement
Slight improvement
Significant improvement
Don't Know
Based on earlier ethnicity question: auto calculate
Lactose Score
Lactose Status
IBD Alert: Have you noticed blood in your stool?
Please Select
Yes
No
Submit
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