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-- Select Descent -- Eurpoean Asian African Oriental MiddleEast

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Parents / Grand Parents had BP / Sugar / Cardiac Problem

Yes No

Are you currently on medication

Yes No

Headaches: Migraine, tension

Respiratory ailments: Asthma,hay fever, bronchitis

Digestive Problems: Ulcers,Irritable bowel, gassiness, acidity

Musculoskeletal: Arthritis,spondylosis, back pain

Skin Problems: Psoriasis,eczema, rash

Immune disorder: Allergies, infections

Daily intake of fruits or vegetables

Milk / Curd or Eggs at least 2-3 times a week

6-8 glasses of Water Daily

Frequent intake of sweets, aerated drinks, fast foods 2-3 times a week

Daily exercise for 30 minutes or more (including walking)

Can you touch your toes

Can you do Push up / Sit up (10 if below 40yrs; 5 for others)

Do you have Job satisfaction (salary, working condition, etc.)

Good home situation (parents, spouse, children)

Major Problems (work, home, financial, health, etc)

Do you have sufficient sleep

Do you consume Alcohol

Do you Smoke

Do you chew Tobacco

Do you follow Safety consciousness

Does your Company provide you Insurance / Hospitalization

Does your Company provide you Annual Health Screening

Does your Company provide you Healthy Canteen

Does your Company provide you Sports Facility

Does your Company provide you Health Education