Health Appraisal Questionnaire

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity - Indigestion

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity - Excessive belching, burping

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity - Bloating or fullness commencing during or shortly after a meal

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity- Sensation of food sitting in stomach for a prolonged period after a meal

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity- Bad breath

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity - Loss of appetite, or nausea

SECTION 1.1 Gastrointestinal System/Stomach: Hypoacidity - History of anaemia

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity- Stomach pain, burning or aching, 1 to 4 hours after eating

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Feeling hungry just an hour or two after eating

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Indigestion or heartburn from spicy or fatty food, citrus, alcohol or caffeine

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Stomach discomfort or pain in response to strong emotions, thoughts or smell of food

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Heartburn aggravated by lying down or bending forward

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Antacids, carbonated beverages, milk, cream or food relieve the above symptoms

SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Constipation

*SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Difficulty or pain when swallowing

*SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Black tarry stools

*SECTION 1.2 Gastrointestinal System/Stomach: Hyperacidity - Vomiting blood or vomitus has 0 appearance of coffee-grounds

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas -Indigestion, bloating and fullness for several hours after eating

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Abdominal cramps or aches

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Nausea and/or vomiting

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Excessive passage of gas

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Diarrhoea (loose, watery or frequent bowel movements)

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Constipation (requiring straining, or a hard, dry or small stool)

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Alternating constipation and diarrhoea

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Undigested food in stools

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Stools greasy, smelly or stick to toilet bowl

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Black tarry stools

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Certain foods worsen abdominal symptoms

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Dry flaky skin and dry brittle hair

SECTION 1.3 Gastrointestinal System/ Small intestine/Pancreas - Difficulty gaining weight

SECTION 1.4 Gastrointestinal System - Lower abdominal pain, cramping and/or spasms

SECTION 1.4 Gastrointestinal System/ Colon - Lower abdominal pain relieved by passing gas or stool

SECTION 1.4 Gastrointestinal System/ Colon - Excessive gas and bloating

SECTION 1.4 Gastrointestinal System/ Colon - Certain foods or stress aggravate lower abdominal pain

SECTION 1.4 Gastrointestinal System/ Colon - Diarrhoea (loose, watery or frequent bowel movements)

SECTION 1.4 Gastrointestinal System/ Colon - Constipation (requiring straining, or a hard, dry or small stool)

SECTION 1.4 Gastrointestinal System/ Colon - Alternating diarrhoea and constipation

SECTION 1.4 Gastrointestinal System/ Colon - Sensation of incomplete emptying of bowel

*SECTION 1.4 Gastrointestinal System/ Colon - Extremely narrow stools

SECTION 1.4 Gastrointestinal System/ Colon - Mucus or pus in stool

SECTION 1.4 Gastrointestinal System/ Colon - Red blood with bowel movement

SECTION 1.4 Gastrointestinal System/ Colon - Rectal pain or cramps

SECTION 1.4 Gastrointestinal System/ Colon -Anal itching

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas- Upper abdominal pain, or pain under ribs

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Bloating or feeling of fullness after eating

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas -Excessive belching or gas

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Fatty foods cause indigestion or nausea

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Loss of appetite

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Nausea and/or vomiting

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Unexplained itchy skin

*SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Yellowish discolouration of skin or eyes, or dark coloured urine

*SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Pale clay-coloured stools

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Fatigue, malaise or weakness

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Fluid retention, oedema

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas- Easy bruising or bleeding (e.g. of gums)

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas- Loss or thinning of body hair

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Red skin, particularly on palms

SECTION 1.5 Gastrointestinal System/ Liver/Gall bladder/Pancreas - Dry, flaky skin or dry hair

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Fatigue, sluggishness

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Feeling cold, or intolerance to cold

*SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Swelling or tightness in front of neck

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Constipation (requiring straining, or a hard, dry or small stool)

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Dry skin and hair

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Puffy face, hands or feet

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Gaining of weight, or decreased appetite

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Low mood

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Difficulty concentrating, poor memory

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Low libido

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Infertility

SECTION 2.1 Endocrine System/ Symptoms of underactive thyroid - Heavier or more frequent menstrual periods

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- Fatigue, notable weakness in limbs

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Feeling hot, or intolerance to heat, sweaty

*SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Swelling or tightness in front of neck

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Diarrhoea (loose, watery or frequent bowel movements)

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Weight loss, possibly with increased appetite

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Palpitations

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Nervousness, irritability, restlessness

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Tremor

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Visual disturbance, problems with eyes, or development of staring gaze

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid- - Poor libido

SECTION 2.2 Endocrine System/ Symptoms of overactive thyroid-- Light, infrequent or absent menstrual periods

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Feeling stressed, nervous, tense or unable to relax

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Feeling irritable or oversensitive

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Feeling overwhelmed, unable to cope

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Low mood, mood swings

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Difficulty concentrating or thinking clearly, memory problems

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Need coffee, tea, tobacco, sugar or chocolate as pick me ups

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Fatigued, tire easily

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Find it hard to get up and going in the morning

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Difficulty staying awake during day

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Insomnia

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Palpitations or chest pain

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals- Nausea, dizziness

SECTION 2.3 Endocrine System/ Stress, fatigue and adrenals - Change in appetite

SECTION 3.1 Immune/ Low immunity - Frequent colds or flu

SECTION 3.1 Immune/ Low immunity- Frequent infections in other locations (e.g. bladder, skin)

SECTION 3.1 Immune/ Low immunity- Diarrhoea

SECTION 3.1 Immune/ Low immunity- Ears continuously drain

SECTION 3.1 Immune/ Low immunity- Nasal congestion or discharge

SECTION 3.1 Immune/ Low immunity - Sore throat

SECTION 3.1 Immune/ Low immunity - Cough with mucus

SECTION 3.1 Immune/ Low immunity - Cold sores

SECTION 3.1 Immune/ Low immunity- Inflamed or bleeding gums, or swollen, red lips or tongue

SECTION 3.1 Immune/ Low immunity- Wounds heal slowly

SECTION 3.1 Immune/ Low immunity - Excessive loss of hair

*SECTION 3.1 Immune/ Low immunity - Neck, armpit or groin swelling

SECTION 3.2 Immune / Allergy- Migraine or non-migraine headache

SECTION 3.2 Immune / Allergy- Sensitivity to light (skin or eyes)

SECTION 3.2 Immune / Allergy - Dark circles under eyes

SECTION 3.2 Immune / Allergy- Swollen eyes, lips, face or other body parts

SECTION 3.2 Immune / Allergy - Localised or general itching – eyes, ears, 0 throat, nose, skin

SECTION 3.2 Immune / Allergy- Rashes or eczema

SECTION 3.2 Immune / Allergy - Clear watery discharge from nose or eyes

SECTION 3.2 Immune / Allergy- Sneezing, coughing or wheezing

SECTION 3.2 Immune / Allergy - Irritability, fatigue

SECTION 3.2 Immune / Allergy - Certain foods worsen symptoms or cause palpitations

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Excessive fatigue

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Prolonged recovery after exercise

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Low exercise tolerance, shortness of breath with exertion

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Difficulty concentrating, poor memory

*SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Yellowing of eyes or skin

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Pale eyelids, lips, gums, nails

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Red sore tongue

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance- Sores in corner of mouth

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Easy bruising or bleeding

SECTION 4.1 Cardiovascular/ Healthy red blood cell maintenance - Dizziness, spots before eyes or ringing in ears

SECTION 4.2 Cardiovascular/ Healthy blood pressure maintenance - Headaches

SECTION 4.2 Cardiovascular/ Healthy blood pressure maintenance- Nosebleeds

SECTION 4.2 Cardiovascular/ Healthy blood pressure maintenance- Redness in face

SECTION 4.2 Cardiovascular/ Healthy blood pressure maintenance - Ringing in ears or blurred vision

SECTION 4.2 Cardiovascular/ Healthy blood pressure maintenance - History of high blood pressure

SECTION 4.3 Cardiovascular/ Heart - Palpitations

SECTION 4.3 Cardiovascular/ Heart - Dizziness

*SECTION 4.3 Cardiovascular/ Heart - Pain or heaviness in central chest

*/SECTION 4.3 Cardiovascular/ Heart - Heartburn, pain or heavy crushing sensation that moves to neck, jaw, left shoulder or arm

*SECTION 4.3 Cardiovascular/ Heart - Pallor or sweating with chest discomfort or with unusual indigestion

SECTION 4.3 Cardiovascular/ Heart - Fatigue easily, poor exercise tolerance

SECTION 4.3 Cardiovascular/ Heart - Shortness of breath with exertion

*SECTION 4.3 Cardiovascular/ Heart - Shortness of breath lying flat in bed, or 8 sudden shortness of breath in the middle of the night

SECTION 4.3 Cardiovascular/ Heart - Wheezing or dry cough

SECTION 4.3 Cardiovascular/ Heart - Veins on neck are prominent

SECTION 4.3 Cardiovascular/ Heart - Swelling in feet, ankles or legs

SECTION 4.3 Cardiovascular/ Heart - History of high blood cholesterol

SECTION 4.4 Cardiovascular / Circulatory system- Poor circulation in extremities: coldness or numbness, tingling or pricking sensations in hands or feet, discolouration in fingers or toes

SECTION 4.4 Cardiovascular / Circulatory system - Ulcers on feet or legs

SECTION 4.4 Cardiovascular / Circulatory system - Muscle pain in calves or thighs with walking

SECTION 4.4 Cardiovascular / Circulatory system - Difficulty concentrating, poor memory

*SECTION 4.4 Cardiovascular / Circulatory system - Faints or falls with unknown cause

*SECTION 4.4 Cardiovascular / Circulatory system - Brief periods of difficulty speaking, swallowing, or understanding speech or written word

*SECTION 4.4 Cardiovascular / Circulatory system- Brief periods of loss of whole or part of vision, double vision, impaired coordination, or areas of numbness

SECTION 5.1 Glucose Tolerance/ Symptoms of hypoglycaemia - When you miss a meal, do you feel...Fatigue and weakness, or feeling shaky

SECTION 5.1 Glucose Tolerance/ Symptoms of hypoglycaemia - When you miss a meal, do you feel...Mild headache

SECTION 5.1 Glucose Tolerance/ Symptoms of hypoglycaemia - When you miss a meal, do you feel...Sweating or palpitations

SECTION 5.1 Glucose Tolerance/ Symptoms of hypoglycaemia - When you miss a meal, do you feel...Feeling light-headed or faint

SECTION 5.1 Glucose Tolerance/ Symptoms of hypoglycaemia- When you miss a meal, do you feel...Difficulty concentrating, poor memory, confusion

SECTION 5.1 Glucose Tolerance/ Symptoms of hypoglycaemia- When you miss a meal, do you feel...Agitation, irritability

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Excessive, frequent urination

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia- Increased thirst and appetite

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Blurred vision, failing eyesight

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia- Fatigue, drowsiness

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Profuse sweating

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Dizziness when standing from sitting position

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Unintentional weight loss or excessive weight gain

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia- Recurrent or persistent infections (e.g. bladder, skin)

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Ulcers or sores on legs or feet

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Slow wound healing

SECTION 5.2 Glucose Tolerance/ Symptoms of hyperglycaemia - Diagnosis of diabetes

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Fluid retention throughout body

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Lower back pain

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Excessive urination

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Excessive urination during night1-2)

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Burning with urination

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Frequent urination

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Urgency of urination

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Bloody, cloudy or darkened urine, or strong-smelling urine

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Incontinence

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Infrequent urination

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder -Grey cast to skin

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - Severe one-sided lower back or groin pain associated with restlessness

SECTION 6.1 Genitourinary System and reproductive hormones/ Kidney/Bladder - History of kidney stones

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Difficulty starting urine flow, or poor flow of urine

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance -Sense of bladder fullness, incomplete emptying, or needing to strain with small amounts of urine passed

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Dripping after urination

*SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Ejaculation causes pain

*SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Blood in semen

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Low libido

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Difficulty attaining or maintaining an erection

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Premature ejaculation

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Low energy level or stamina

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Infertility, low sperm count or poor motility

*SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance -Inflammation of penis, or unusual discharge from penis

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance -Genital or groin rash, irritation, itchiness or infection

*SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Painful testicle(s)

*SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Testicles uneven in size, texture or hardness

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Both testicles appear smaller

SECTION 6.2 Genitourinary System and reproductive hormones/ Prostate/Male hormone balance - Loss or thinning of body or facial hair, or slow hair growth