|
|
|
Symptom |
None |
Not much |
A fair bit |
A lot |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1. |
Headaches (including migraines) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
2. |
Lack of energy and vitality |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
3 |
|
|
|
3. |
Candida - jock itch, thrush, tinea ... |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
5 |
|
|
|
4. |
Poor sleep. (On medication score 10) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
4 |
|
|
|
5. |
Snoring &/or sleep apnoea. (On gas mask score 10) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
6. |
Crook back, sore shoulders, RSI ... |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
3 |
|
|
|
7. |
Frequent colds, flu, sinus |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
8. |
Unsettled stomach,
reflux ... |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
9. |
Overweight - 1 point for every 2Kg |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
5 |
|
|
|
10. |
Irritable bowel, constipation, diarrhoea |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
11. |
Shortness of
breath, asthma |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
12. |
Low level of aerobic fitness |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
13. |
Chest pain, palpitations |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
14. |
Rashes, itchiness, psoriasis, zits |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
4 |
|
|
|
15. |
Mouth ulcers, cold sores |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
16. |
Elevated blood pressure. (On medication score 10) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
6 |
|
|
|
17. |
Elevated blood cholesterol (On medication score 10) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
2 |
|
|
|
18. |
Elevated blood glucose (On medication score 10) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
1 |
|
|
|
19. |
Shakes, nervous ticks, mannerisms |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
2 |
|
|
|
20. |
Grinding teeth |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
21. |
Alcoholic drinks per day (2 pts/drink) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
1 |
|
|
|
22. |
Smoking. (1 pt/cigarette/day) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
23. |
Caffeine (1 pt/cup per day) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
2 |
|
|
|
24. |
Anxious about life and/or feel insecure or apprehensive |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
4 |
|
|
|
25. |
Sad or depressed (On medication, score 10) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
26. |
Are you in the wrong job. (Score high if yes.) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
27. |
Under-appreciated at work |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
0 |
|
|
|
28. |
What's your work/life balance like? (Score high it's it
poor) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
5 |
|
|
|
29. |
Unhappy with your family life? (If yes, score high) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
1 |
|
|
|
30. |
Unhappy with your financial status. (If yes score
high) |
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
10 |
|
