The test and the assessment are performed according to the International Medical Standards.
1. How often do you consult your physician and for what reason?
2. Have you been diagnosed with :Cardiovascular diseases (hypertension, coronary disease)HyperlipidaemiaHypercholesterolemiaThyroidopathyStrokeDeep vein thrombosisHormonal issuesKidney DiseasesPulmonary DiseaseNeurological diseasesLiver DiseaseIrritable Bowel SyndromeAsthmaAllergiesSkin Diseases
3. Please mention any other diseases not listed above:
4. Do you smoke? NoYes
4.1 If Yes, how many cigarettes?
4.2 And for how long?
5. Do you have intense physical activity? NoYes
6. Do you feel fatigue? NoYes
7. Please mention any medications or supplements that you take
8. What is your main health issue?
9. Has your daily life changed and to what extend?
10. Do you have sugar cravings? NoYes
11. Have you experienced recently difficulties in losing weight?NoYes
12. Have you noticed increased thirst, increased urination or changes in your eating habits? NoYes
13. Please mention whether you follow a specific diet
Age
Name
Surname
Preferred Contact Hours MorningAfternoon
Address
City
Telephone
E-mail
Message
Accept I have read and agreed with the terms of use, privacy policy and cookie regulations based on GDPR law and I consent to give my personal information.