Health Index

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33 Questions - Developed by: Hannah Baird - Developed on: - 890 taken

Please answer truthfully

  • 1
    On average, how many hours of sleep do you get a night?
    9-10
    7-8
    5-6
    4 or lower
  • 2
    How often do you exercise?
    Never
    Once-twice a week
    Three-four times a week
    Five-six times a week
    Once a day
  • 3
    Would you say you meet the recommended meal planning requirements
    Would you say you meet the recommended meal planning requirements
    No
    Sort Of
    Most of the Time
    Always
  • 4
    On average, how much water do you drink daily?
    15+ cups
    11-14 cups
    8-10 cups
    4-7 cups
    0-3 cups
  • 5
    In a situation, which best describes you?
    I think positively to move through
    I dwell and think negatively
    A combination of both
  • 6
    According to the BMI chart, where do you lie?
    According to the BMI chart, where do you lie?
    Underweight
    Normal range
    Overweight
    Obese
  • 7
    Do you have an eating disorder of any sort?
    Yes
    No
    I use to, but now anymore
  • 8
    Do you: accept yourself and others, adapt to and manage emotions, and deal with the demands and challenges you meet in life?
    Always
    Often
    Sometimes
    Not usually
    Never
  • 9
    On a scale of 1-5, how risky are you?
    1
    2
    3
    4
    5
  • 10
    Do you have any non severe mental disorders (OCD, Bipolar Disorder, Clinical Depression, PTSD, etc.)
    Yes
    No
    I do, but I am on medications and show no symptoms
  • 11
    Do you suffer from any severe mental disorders ( schizophrenia, etc.)
    Yes
    No
    I do, but I am on medication and show no symptoms
  • 12
    Have you ever considered suicide?
    Never
    Rarely
    Sometimes
    Often
    Always
  • 13
    On a scale of 0-10, how stressed do you feel on a day to day basis?
    0-2
    3-5
    6-8
    9-10
  • 14
    Which best describes your peer, family, and partner relationships?
    I have none
    My relationships are comfortable and beneficial
    My relationships are abusive and hurtful
  • 15
    Which best describes your family?
    I have no family
    My Family is built on mutual love and respect
    My family is built on hate and disrespect
  • 16
    Which peer pressure do you find most in your peer, family, and partner relationships?
    I have no peer, family, or partner relationships
    Positive (encourages you to participate in good things, role models, positive acts)
    Negative (encourages behaviors with negative consequences, manipulation, hurtful)
  • 17
    How many of the following risk factors for a skeletal system disorder apply to you: Poor nutrition, infections, sports and recreational injuries, poor posture
    0-1
    2
    3
    4
    5
  • 18
    How often do you participate in drug use?
    Never
    Sometimes
    Often
    Always
  • 19
    How often do you consume alcohol?
    Never
    Sometimes
    Often
    Always
  • 20
    How often do you consume tobacco?
    Never
    Sometimes
    Often
    Always
  • 21
    Do you have a cardiovascular system disorder?
    Yes
    No
    I do not know
  • 22
    Which of the following apply to you?
    I have a mild infection in my respiratory system
    I have a respiratory system disorder
    None of the above
  • 23
    On average, how often do you brush and floss your teeth?
    Twice a Day
    Once a day
    Once a week
    Once a month
    Never
  • 24
    Which of the following apply to you?
    I have cancer
    I do not have cancer
    I am currently in remission
  • 25
    On a scale of 0-4, how bad is your asthma?
    0 (I do not have asthma)
    1
    2
    3
    4
  • 26
    Do you have diabetes?
    Yes
    No
    Yes, but not bad
  • 27
    How is your arthritis?
    I do not have arthritis
    I have mild arthritis
    I have severe arthritis
  • 28
    Which of the following apply to you?
    I am deaf
    I am blind
    All of the above
    None of the above
  • 29
    Do you have mental retardation?
    Yes, severely
    Yes, mildly
    No, not at all
  • 30
    How often do you have a bowel movement?
    More than three times a day
    Two times a day
    Once a day
    Once every two-three days
    Once every 4+ days
  • 31
    Are you exposed to pollution?
    Yes, indoor air pollution (asbestos, smoke, certain building and furnishing materials)
    Yes, noise pollution (traffic, loud music, power tools, etc)
    All of the above
    None of the above
  • 32
    Do you have any diseases or conditions that affect your body in a negative way?
    No
    Mildly
    Yes
    Very strongly so
  • 33
    On a scale of 0-10, how much energy do you have through the day on average?
    0
    1-3
    4-6
    7-9
    10

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