Questionnaire, Are you as healthy as you think?

Age / gender

Male Female    Age < 17 18-24 25-34 35-54 55+

Medical History

Heart condition   Eating disorder   Respiratory condition   No medical conditions

Body Stats

        BMI -18 Underweight 18-25 Normal 25-30 Overweight 30-35 Obese 35-40 Very Obese 40+ Morbidly Obese    Blood Pressure Unknown Normal ->120/80 PreHypertsnsive 120-139/80-89 Hypertensive 140-159/90-94 Acute hypertensive 160+/100+    Resting Heart Rate < 60 60-70 70-80 80-90 90-100 100+

BMI is the proportion of your height to weight if you dont know your BMI then calculate it here.

Activity

   Activity Sedentary Moderate activity Active Excessive activity Normal daily i.e Work or daily routine. Must indicate regular activity 3-5 days per week

Exercise Never Occasional, 1-2 monthly Weekly, 1-2 weekly Regular 2-4 weekly Daily     Duration - 15 minutes 15-25 minutes 25-45 minutes 45 +     Intensity Gentle Moderate - Endurance Intense - Aerobic Very Intense - Lactic Extreme - Max HR

Diet

Portions Small Medium Large     Frequency Variable- different daily 1 Meal Daily 2 Meals Daily 3 Meals Daily 4+ Meals Daily (not snacks)     Times Evenly throughout the day Mid Day no breakfast Mid Day with breakfast Mid Day to Early Evening Mid Day to Late Evening Late Evening

    Food Vegetarian Balance fresh veg,fruit and meat Balance fresh veg,fruit and meat with occasional take out Mostly processed foods and take out Processed foods and take out only    Drinks Plenty of water or still fruit juice Mixed water ,juice,tea, coffee, fizzy pop Tea, coffee and fizzy pop only very little fluids taken

Snacks Never Occasionally Daily Frequently     Salt Never apply salt Occasional light use Regular light use or occasional heavy use Regular heavy use     Sugar Light use Moderate use Heavy use

Please select the option which is closest to you normal diet parameters.

Habits

Smoking Non smoker Occasional < 10 daily 10-30 daily > 30 daily      Drinking Non Drinker Occasional Drinker Daily moderate amounts Daily large amounts

Stress

    Work Never feel stressed Occasional feel stressed Regularly feel stressed Always feel stressed     Home Never feel stressed Occasional feel stressed Regularly feel stressed Always feel stressed