Health questionnaire

Determine your health field(s) to better understand your potential weaknesses and correct them to stay healthy.

Enter your personal information


Questions from Q1 to Q96 are mandatory to obtain a report

  • Q1 : Do you feel sad, do you have moments of melancholy, or do you cry frequently?

  • Q2 : Do you consider yourself sociable but with great emotion or shyness?

  • Q3 : Do you get angry easily?

  • Q4 : Are you stressed in your daily life, do you have personal or professional concerns?

  • Q5 : Do you tend to devalue yourself, do you feel a general lack of desire, are you in a situation of depression?

  • Q6 : Do you feel impatient, changeable and occasionally irritable?

  • Q7 : Do you have causeless anxieties, strong anxiety?

  • Q8 : Do you feel a lack of motivation, a difficulty in launching new projects?

  • Q9 : Do you have a generally disturbed, restless and not restful sleep?

  • Q10 : Do you have trouble falling asleep?

  • Q11 : Do you have an early awakening (around 3 to 4 am) and / or morning fatigue?

  • Q12 : Do you generally feel tired and noticeably worsened by physical exercise?

  • Q13 : Are you looking for and enjoying the spicy taste in your diet like peppers or mustard?

  • Q14 : Are you looking for and enjoying the sweet taste in your diet?

  • Q15 : Are you looking for and enjoying the salty taste in your diet?

  • Q16 : Are you looking for and enjoying the bitter taste in your diet (coffee / suze …)?

  • Q17 : Are you looking for and enjoying the sour taste in your diet like lemon or vinegar?

  • Q18 : Are you chilly? But do you feel better when you rub your body to warm up?

  • Q19 : Does applying pressure on a painful area of ​​your body improve the situation and decrease the pain?

  • Q20 : Does applying heat locally to a painful area of ​​your body improve the situation and reduce the pain?

  • Q21 : Your health situation see your health problem if you have one, is it made worse by the wet weather?

  • Q22 : Does applying cold locally on a painful area of ​​your body improve the situation and reduce the pain?

  • Q23 : Does setting in motion a painful area make the pain worse?

  • Q24 : Do you experience chronic or repeated pain?

  • Q25 : Do you have parents who have or have had gout problems?

  • Q26 : Do you have parents with diabetes and/or with cholesterol?

  • Q27 : Do you have anal or genital itching?

  • Q28 : Do you have psoriasis (dry, scaly dermatitis)?

  • Q29 : Do you have dry skin and mucous membranes?

  • Q30 : Do you have pimples, blackheads or yeast?

  • Q31 : Do you have multiple lipomas or warts?

  • Q32 : Do you have brittle and easily broken nails?

  • Q33 : Do you have hives or have you recently had angioedema?

  • Q34 : Do you have canker sores, sensitive gums or periodontoses?

  • Q35 : Do you have anal fistulas and / or fissures and / or varicose ulcer?

  • Q36 : Do you have recurrent oral and / or genital herpes?

  • Q37 : Do you have hemorrhoids? Who are going out or who are currently bleeding?

  • Q38 : Do you have eczema problems?

  • Q39 : Do you have constipation or dry stools for more than 2 days?

  • Q40 : Do you have diarrhea problems that last more than 3 days or do you have a bowel movement more than 6 times a day?

  • Q41 : Do you have aerophagia problems (bloating / burping) and / or gastralgia or / and stomach ulcers?

  • Q42 : Do you have alternating diarrhea and / or constipation problems?

  • Q43 : Are you anemic (or with a low ferritin level)?

  • Q44 : Do you regularly have cramps or spasms?

  • Q45 : Do you have tendonitis or periarthritis (with morning joint rusting)? And / or a need to ‘untie’ your joints when you wake up (do you feel joint pain when you get up and take your first steps?

  • Q46 : Do you have arthritis, cervical and / or lumbar and / or sciatica and / or hips and / or knee arthritis problems?

  • Q47 : Do you have osteoporosis?

  • Q48 : Do you have varicose veins? Did you perform a stripping operation?

  • Q49 : Do you have problems with anorexia, bulimia or eating disorders?

  • Q50 : Do you have a chronically charged tongue and / or breath?

  • Q51 : Do you have conjunctivitis? And / or the red and painful eye from time to time with discomfort aggravated by the light?

  • Q52 : Do you have repeated ENT infections (angina / otitis / sinusitis)?

  • Q53 : Are you prone to hay fever (pollinosis)?

  • Q54 : Do you have multiple allergies (hay fever and / or asthma, eczema, hives, migraine)?

  • Q55 : Do you have one or more food intolerances (verified biologically)?

  • Q56 : Do you have frequent bronchitis or coughing problems?

  • Q57 : Do you have asthma or asthmatic bronchitis?

  • Q58 : Do you have one or more addictions like tobacco, snacking on sweets, games or alcohol?

  • Q59 : Do you smoke more than 10 cigarettes a day on average?

  • Q60 : Do you take more than one glass of alcohol per meal?

  • Q61 : Do you regularly take anti-inflammatory or cortisone medications?

  • Q62 : Do you regularly take tranquilizers or antidepressants?

  • Q63 : Do you take pain relievers?

  • Q64 : Are you taking cholesterol lowering drugs or are you undergoing chemotherapy?

  • Q65 : Have you recently had a Hepatitis B, Yellow Fever, Typhoid or Papilloma vaccine?

  • Q66 : Do you have memory and concentration problems?

  • Q67 : Do you have obsessions and fixed ideas?

  • Q68 : Do you have tics or tremors in the extremities?

  • Q69 : Do you have real migraine problems (unilateral throbbing headache)?

  • Q70 : Do you have real vertigo problems like Ménière’s disease?

  • Q71 : Do you have problems with ringing in the ears and / or ringing in the ears in one ear?

  • Q72 : Do you have problems with ringing in the ears and / or ringing in the ears in both ears?

  • Q73 : Do you have significant hair loss problems?

  • Q74 : Do you have gallstones that have been operated on or not?

  • Q75 : Do you get bruises easily and / or do you bruise when you bump and / or do you have purpura?

  • Q76 : Do you have heart rhythm problems?

  • Q77 : Do you have high blood pressure (under treatment or not)?

  • Q78 : Do you have thyroid problems like a simple nodule or goiter…?

  • Q79 : Do you have thyroid problems like Graves’ disease or Hashimoto’s disease?

  • Q80 : Do you have a prostate adenoma / uterine fibroid?

  • Q81 : Do you experience burning burning when urinating, do you have problems with repeated cystitis?

  • Q82 : Do you have problems with kidney stones (urinary stones)?

  • Q83 : Are you thirsty regularly with the need to drink several times a day?

  • Q84 : Do you have recurrent acute infections?

  • Q85 : Do you have an autoimmune disease (such as arthritis, Hashimoto, Crohn, etc.)?

  • Q86 : Do you have cancer? Or have you had cancer recently?

  • Q87 : Do you have mastoses such as lumps or long-term breast congestion?

  • Q88 : Do you take birth control pills?

  • Q89 : Do you experience hot flashes and / or do you have a weight gain problem?

  • Q90 : Are you taking hormone replacement therapy (peri-monopause) in progress?

  • Q91 : Do you have irregular periods?

  • Q92 : Do you have premenstrual disorders and / or dysmenorrhea?

  • Q93 : Do you have Leucorrhea and / or itching and / or Bartholinitis?

  • Q94 : Have you had a hysterectomy?

  • Q95 : Do you have a frigidity problem, a lack of desire?

  • Q96 : Do you have erection problems, impotence problems?

Questions Q97 to Q114 are not mandatory but only additional information to help us give you more accurate answers

  • Q97 : Do you have a specific reason for taking this Health Check questionnaire?

  • Q98 : What is the history of your dysfunctions? (since when, how and why?)

  • Q99 : Do you have one or more known, diagnosed diseases (chronic, genetic, or autoimmune)?

  • Q100 : Are you currently undergoing medical treatment? If yes which ?

  • Q101 : Do you take plants or food supplements? If yes, which ones, since when and why?

  • Q102 : Have you had any injuries, recent or past? Which ones?

  • Q103 : Have you had any surgery. If yes, which ones and when?

  • Q104 : Do you have food allergies or intolerances?

  • Q105 : What are your eating habits ? Do you follow a specific diet?

  • Q106 : Do you do any physical activity or sport (what, since when, how often)?

  • Q107 : Do you live Alone or as a couple?

  • Q108 : Do you have children?

  • Q109 : How ?

  • Q110 : How would you define your current emotional state?

  • Q111 : What is the quality of your family and friendly relationships?

  • Q112 : Do you have a professional activity? Which ? What is the stability, the arduousness (stress, pleasant environment, polluted, relations with colleagues)

  • Q113 : What is your living environment? (City, countryside, pollution, neighborhood)?

  • Q114 : Do you have any other information about your health that you would like to share with us?

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