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Krishna Kumar
8630586970
8630586970
Profile
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H+ Points
Surveys
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Community
General
Diabetes
CVD
Mental Health
Name
Date
Time
H+ Points
Name
22' Jan 2022
22' Jan 2022
2 H+ Points
Heading 6
Name
22' Jan 2022
22' Jan 2022
Heading 6
Name
22' Jan 2022
22' Jan 2022
Submission Date : 22/08/2022
1. Full Name
2. Gender
Male
Female
Other
3. Contact Information
ISD
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Phone No.
Email
4. What is your Health Goal ?
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If other (Please Specify)
5. Date of Birth
6. Height
Feet
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Inch
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7. Weight (in Kg)
8. Waist Circumference ( in Inches ) :
9. Do you have any medical concerns? Please select all that apply.
Type 2 Diabetes / Prediabetes
Type 1 Diabetes
Hypertension
Heart Disorders (Coronary Artery Disease (CAD)/ Heart Arrhythmias/ Heart Failure/ Heart Valve Disease/ Pericardial Disease/ Cardiomyopathy/ Congenital Heart Disease)
Obesity or Overweight
High Waist Circumference or Belly Fat
Endometriosis
PCOS / PCOD
Thyroid Disorders (Hypothyroidism/ Hyperthyroidism/ Hashimoto's Disease/ Grave's Disease/ Goiter)
High cholesterol or high lipids or high triglycerides (hypercholesterolemia/ dyslipidemia/ hypertriglyceridemia)
Kidney disorders (high serum creatinine/ urine microalbumin)
Fatty Liver
Gastrointestinal Disorder (Inflammatory bowel disease/ Irritable Bowl Syndrome/ Celiac Disease/ GERD/Acid Reflux/ SIBO)
Mental Health Disorder (Clinical Depression/ Anxiety Disorder/ Schizophrenia/ Bipolar Disorder/ Dementia/ OCD/ PTSD)
other
None
If other (Please Specify)
10. Do you have family history of any of these conditions? Please select all that apply.
Type 2 Diabetes / Prediabetes
Type 1 Diabetes
Hypertension
Heart Disorders (Coronary Artery Disease (CAD)/ Heart Arrhythmias/ Heart Failure/ Heart Valve Disease/ Pericardial Disease/ Cardiomyopathy/ Congenital Heart Disease)
Obesity or Overweight
High Waist Circumference or Belly Fat
Endometriosis
PCOS / PCOD
Thyroid Disorders (Hypothyroidism/ Hyperthyroidism/ Hashimoto's Disease/ Grave's Disease/ Goiter)
High cholesterol or high lipids or high triglycerides (hypercholesterolemia/ dyslipidemia/ hypertriglyceridemia)
Kidney disorders (high serum creatinine/ urine microalbumin)
Fatty Liver
Gastrointestinal Disorder (Inflammatory bowel disease/ Irritable Bowl Syndrome/ Celiac Disease/ GERD/Acid Reflux/ SIBO)
Mental Health Disorder (Clinical Depression/ Anxiety Disorder/ Schizophrenia/ Bipolar Disorder/ Dementia/ OCD/ PTSD)
other
None
If other (Please Specify)
11. Do you experience any of these symptoms ?
Extreme Thirst
Frequent Urination
Vision problems
Dry & itchy skin
Low energy / Tiredness
Hypoglycemia
Confusion / Brain Fog
Anxiety
Mood Swings
Numbness / Tingling in Hands or Feet
Lightheadedness / Fainting
Shortness of Breath
Nosebleeds
Heart Palpitations
Hunger Pangs
Irregular Menstrual Cycle
Acne
Hirsutism
Thinning of Hair
Stress
Constipation
Acidity
Bloating
