Your Health

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What is Your Age



My Height is


My Weight is


Most recent random blood sugar/fasting blood sugar

Most recent blood presure reading

* (Avg - 130/90 mm of Hg)

Recent/Today's cholesterol level

(Avg - Below 200 mg/dL)

Any family history of diabetes?

Any family history of hypertension?

Any health issue?

Have you ever been diagnosed with any of the following disease/condition(s)?

Taking any treatment for Diabetes?

Does Diabetes affect your routinelife at work/home?

Taking any treatment for hypertension?

Does hypertension affect your routinelife at work/home?

Taking regular treatment for cholesterol?

Have you modified your lifestyle for cholesterol?

Any previous asthmatic attack?
(More than two)

Do you smoke?

Per day sticks?

Per week sticks?

Your best physical activity?

Your best dietary practice?

Your eating habits?

Have you felt anxious, nervous or restless in previous month?

Have you felt depressed or sad in previous month?

Have you felt overwhelmed with stress from responsibilities, situations or relationships?

Your dosage for eating fried & junk food?

Your alcohol drinking behavior?


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