General Health

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Thank you for taking the time to complete this Health and Wellbeing questionnaire. Your responses will help us understand your current state of health and wellbeing and identify areas where we can offer support and guidance. Please answer all questions as honestly and accurately as possible.

How would you rate your overall health?

Excellent

Good

Fair

Poor

Have you experienced any of the following health issues in the last six months? (Select all that apply)

Headaches

Digestive issues (e.g. bloating, constipation, diarrhea)

Respiratory issues (e.g. coughing, wheezing, shortness of breath)

Skin issues (e.g. rash, hives, itching)

None of the above

How many hours of sleep do you typically get per night?

Less than 5 hours

5-6 hours

6-7 hours

7-8 hours

More than 8 hours