2. How often does this describe you? “The lower number on my blood pressure reading (diastolic) is usually below 80.
You must select an answer
Almost always.
Occasionally
Never
3. Does this describe you? “I have burning or uncomfortable sensations in my hands or feet and/or been diagnosed with carpal tunnel or ‘restless legs syndrome’ and /or my hands shake when I am hungry or stressed”
You must select an answer
Yes
Sometimes
No
4. Does this describe you? “I get headaches twice monthly or more.”
You must select an answer
Yes
Sometimes
No
5. How often does this describe you? “I tend to get very tired in the afternoon between 3 and 5 pm.”
You must select an answer
Never
Sometimes
Frequently
6. How well does this describe you? “I have a really hard time losing weight, and I regain it rapidly.”
You must select an answer
Not at all
Somewhat
Exactly
7. Does this describe you? “My fasting blood sugar is over 100, or my doctor told me I’m pre-diabetic or diabetic.”
You must select an answer
No
Yes
Yes, I'm diabetic
8. How often does this describe you? “My ankles and feet swell after I’ve sat for a while.”
You must select an answer
Never
Sometimes
Often
9. How often does this describe you? “I get heartburn or take medications to control heartburn.”
You must select an answer
I never or very rarely experience heartburn issues
I experience heartburn once a week
I experience heartburn twice a week or more
10. How well does this describe you? “I have a sweet tooth or crave starchy foods, and when they are around, I tend to eat more of them than I want to.”
You must select an answer
Not at all
Somewhat
Exactly
11. How well does this describe you? “I tend to have something sweet or starchy at most meals, or I obsess about starchy and sweet foods when I can’t have them.”
You must select an answer
Not at all
Somewhat
Exactly
12. How well does this describe you? “I can lose a certain amount of weight, but then my energy crashes and I stop dieting.”
You must select an answer
Not at all
Somewhat
Exactly
13. How well does this describe you? “I am the warm person in the room wanting to turn the thermostat down, or activity can make me feel uncomfortably hot or sweaty, especially when I’m pressed for time.”
You must select an answer
Not at all
Somewhat
Exactly
14. How well does this describe you? “I take every shortcut I can – using the elevator and driving around the parking lot looking for the slot closest to the entrance.”
You must select an answer
Not at all
Somewhat
Exactly
15. How well does this describe you? “When I put on weight it tends to accumulate around my belly and neck or under my chin.”