Page 1 of 3
Family Health Survey
You are invited to take this survey, it takes less than 2 minutes.
Currently, what is your biggest challenge in maintaining good health?
*
Have a healthy diet
Sleep well
Drink enough water
Exercise regularly
Reduce stress
This survey addresses common health conditions in all families
(including spouse, parents, siblings, children, uncles, aunts, cousins, and other relatives)
In your family, does anyone have or has ever had:
*
Diabetes
High Cholesterol
Uric Acid
High/Low Blood Pressure
Thyroid
Thrombosis
Asthma
Sinusitis
PMS
Migraine
Arthritis
Fibromyalgia
Osteoporosis
Psoriasis
Gastritis
Constipation
Gallstones
Kidney Stones
Parkinson's Disease
Allergies
Cancer
Other
If you could only improve ONE of the selected conditions, which one would you choose?
