Functional Health Index (FHI)

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First Name* This field is required.

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Email* This field is required.Your results will be emailed to you

example@example.com

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Birth Sex

Female

Male

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Please answer all questions. Your total FHI score will be given only if all of the questions with a * are answered.

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I have more than three or less than one bowel movements per day* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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Constipation or Diarrhea

Daily

Several times a week

several times a month

almost never

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I pass foul smelling gas* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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Stomach bloating or sick feeling after meals* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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Heartburn* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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General fatigue* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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Hungry shortly after eating* This field is required.

After at least 2 meals a day

After at least 1 meal a day

After a few meals per week

Almost never

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Difficulty losing weight* This field is required.

Struggled all my life

Struggled for over 1 year

Occasionally have issues with weight gain

Maintain proper set point weight

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Brain fog/difficulty focusing* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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Heart palpitations* This field is required.Irregular heart rate

Daily

Few times per week

Few times per month

Almost never

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Have to get up to urinate at night* This field is required.

Nightly

Several nights a week

Several nights a month

Almost never

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Wake up tired in the morning* This field is required.

Most every day

Several times a week

At least a few times per month

Almost never

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Take prescription sleeping medication* This field is required.

Nightly

Several nights a week

A few nights a month

Never

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Low sex drive* This field is required.

Most of the time

At least 50% of the time

Occasionally

Almost never

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Female Only - Facial hair growth

Present more than one year

Present for less than one year

periodic/occasionally

Never

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Female Only- Menstrual periods lasting more than five days

Every cycle

Most cycles

Occasionally

My cycles are regular

I am post menopausal

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Female Only- Irregular Menstrual cycle (more than 5 day difference)

Every cycle

Most cycles

Occasionally

Almost never

I am post menopausal

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Female Only- Unable to conceive

Yes

No

Unknown

post menopausal

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Men Only - Erectile dysfunction

More than 75% of the time

50% - 75% of the time

Less than 50% of the time

Never

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Men Only - Increased fat around the chest and hips

More than two years

One to two years

Less than a year

Never

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Muscle cramping/muscle twitching during the day or night* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

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Hair loss* This field is required.

Large patches lost (not male baldness)

Significant thinning

Some thinning but I am not concerned

Almost never

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Athletes foot/nail fungus/etc.* This field is required.Itching, skin cracking, thickened/discolored nails

Symptoms at least 75% of the time

Symptoms between 25% - 50% of the time

Have symptoms a few times per year

Almost never

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How often do you have depression-like feelings.* This field is required.

Daily

Few times per week

Few times per month

Almost never

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How is your sense of smell.* This field is required.

Poor (can't even smell peanut butter)

Over sensitive to smells

Great

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Wake often during the night* This field is required.

Nightly

Several nights a week

Several nights a month

Almost never

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Crave sweets or chocolate.* This field is required.

Daily

Few times per week

Few times per month

Almost never

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"Aches and pains" throughout your body.* This field is required.That affects your mobility/activity

Daily

Few times per week

Few times per month

Almost never

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Skin outbreaks, acne, rashes, extreme dry skin, eczema, psoriasis* This field is required.That affect you mobility/activity

Constantly

Every few months

Few times a year

Never

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Do you have dizziness when standing up quickly.* This field is required.

Most of the time

Few times per week

Few times per month

Almost never

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How often do you have swelling (edema) in your ankles and/or wrists.* This field is required.

Daily

Few times per week

Few times per month

Almost never

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How often do have cold hands and or feet* This field is required.Or are cold all over

Most of the time

Several times a day

Few times per week

Few times per month

Almost never

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Notice thinning of your outer eyebrows* This field is required.

Yes

No

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General headache* This field is required.

Daily

Few times per week

Few times per month

Almost never

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Migraine headache* This field is required.Can be piercing or throbbing pain, often accompanied by sound and light sensitivity.

Daily

Few times per week

Few times per month

Almost never

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Headache when waking up in the morning or from a rest* This field is required.

Daily

Few times per week

Few times per month

Almost never

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Physical stamina* This field is required.

Difficult to make it through the day

Start strong and weaken quickly during the day

More fatigued than I think I should be, but make it through the day

Physically strong all day

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Declining memory* This field is required.

I notice it, or others tell me of it several times a day

I notice it, or others tell me of it several times a week

I notice it, or others tell me of it several times a month

Almost never

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Stress level* This field is required.

I'm stressed all of the time

Feel higher level of stress than what I want

Feel at peace most of the day

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I feel that my life is unfulfilling* This field is required.

Daily

Few times per week

Few times per month

Almost never

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It is difficult to work with numbers* This field is required.

Daily

Few times per week

Few times per month

Almost never

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Chemical sensitivities* This field is required.

I react to many common cleaners, perfumes, etc.

I have to be careful with some common cleaners

I sometimes have a reaction to common chemicals

Almost never have any reaction to chemicals

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Tinnitus* This field is required.Ringing or buzzing in your ear

Daily

At least a few times per week

At least a few times per month

Never

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Your FHI Score

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Healthy range messageHealthy range

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Improvement Needed MessageYour health needs improvement. Your body often sends signals long before disease develops. Understanding those signals can help you protect your health. Learn what your score means https://goodmedicinefh.com/what-does-your-fhi-mean/

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Serious Improvement Needed MessageYour body needs significant attention. Your body often sends signals long before disease develops. Understanding those signals can help you protect your health. Learn what your score means https://goodmedicinefh.com/what-does-your-fhi-mean/

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Thank you for completing your 5-Minute Health Assessment

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Schedule a Discovery Call

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Jot Form FHI