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

12

General fatigue* This field is required.

Daily

Several times a week

At least a few times per month

Almost never

13

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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So what does your total FHI mean?

Click submit and you will recieve an email with link to FHI rating page.

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Jot Form FHI