1. Do you get headache on and often
2. Do you feel dizzy often
3. Do you experience difficulty in hearing
4. Do you experience difficulty in seeing objects
5. Do you hear noises in your ear
6. Any h/o bleeding from nose often
7. Do you have bleeding gums
8. Do you have numbness in any point of the body
9. Do you get fever often
10. Do you have back pain often
11. Does your skin develop rashes often
12. Does your skin involve itching
13. Do you have chest pain
14. Do you feel tightness of chest
15. Do you sense breathlessness
16. Do you have swelling of legs
17. Do you experience difficulty in swallowing
18. Do you suffer from indigestion
19. Do you cough often
20. Does your sputum contain blood
21. Does your sputum smell putrid
22. Do you suffer from rectal bleeding
23. Do you have difficulty in urinating
24. Have you observed blood in urine
25. Do you get nervous break downs often
26. Dont you communicate well
27. People do not feel comfortable to interact with you
28. Do you hide your feeling to avoid criticism
29. Do you avoid attempting things that you may not excel
30. Do you critisize others
31. Are you sluggish/Lack proper sleep
32. Are you anxious about unproductive hours
33. Do you feel depressed about weight
34. Dont you easily acclimatise to changes
35. Do you have phobias
36. Do you need structural preparation to fit in a new situation
37. Are you hurt, angered, or made to feel guilty easily
38. Are you very dependent person
39. Are you not assertive
40. Does physical touch annoy you
41. Do you suppress your feelings
42. Do you eat as a response to your emotions
43. Do you eat more in company
44. Do you feel being overweight makes you powerful
45. Do you have less than one enjoyable sexual experience each week/fortnight

a]-Women --> Any menstrual irregularities

b]-Men--> Impotence

47. H/O Sexual dysfunction
48. Do you suffer from any medical illness/terminal illness
49. Have you undergone surgeries/met with accidents
50. Do you think you need no extra help in changing self neglecting personality traits
51. Are you a smoker/alcoholic
52. Are you on any regular medications
53. Do you avoid exercise/meditation
54. Are you skeptical about cosmic energy
Note: Your health cheque value increases with more NO'S and decreases with more YES'S


0 TO 25---POOR



45 TO 54--GOOD

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