Fill in your details below to start your Free Health Check Welcome to your FREE Health Check. All answers should to be given in numbers between 0 - 10 to gauge the Intensity of your symptoms, if you have any. Please gauge your severity as follows: 10 = Very High Intense Uncomfortable Sensations 0 = Feeling nothing 1-2-3-4-5-6-7-8-9 = everything in between 0-10 Findings from the quiz will be emailed to you within 48 hours maximum. If you do not receive a reply from us within that time frame then please get in touch at Rachel@live4energy.co.uk. Thank you for sharing how you're feeling right now. Fill in your details below to start the Free Health Check Name Email Phone Number 1. DO YOU HAVE A BUILD UP OF PRESSURE IN THE BACK OF THE HEAD? Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 2. DO YOU HAVE MUSCLE OR JOINT PAIN? Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 in here! Please select your answer 0 1 2 3 4 5 6 7 8 9 10 3. DO YOU SUFFER FROM FATIGUE? Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 4. DO YOU SUFFER FROM CONFUSION OR BRAIN FOG? Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 5. ARE YOU FORGETFUL? Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 6. DO YOU SUFFER FROM INSOMNIA (ie struggling to get to sleep or waking often etc) Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 7. DO YOU SUFFER FROM DIZZINESS? Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 8. I SUFFER FROM SHORTNESS OF BREATH (more often than normal) Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 9. I'VE HAD A COUGH FOR MORE THAN 2 WEEKS Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 10. I SUFFER FROM HEADACHES (migraines) Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 11. I HAVE LOST MY SENSE OF SMELL AND TASTE Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 12. I GET ANXIOUS AND AGITATED Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 13. MY SKIN IS ITCHY (INCLUDING SCALP) Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 14. I SUFFER FROM ABDOMINAL ACHES/PAIN Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 3 3 4 5 6 7 8 9 10 15. I SUFFER FROM CHEST PAIN/ACHES Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 16. I SUFFER FROM HEART BURN / INDIGESTION Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 17. I HAVE LOST MY APPETITE Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 18. I SUFFER FROM LUMPY THROAT SENSATIONS Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 19. I SUFFER FROM SORE THROATS OR HOARSENESS Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 20. I SUFFER FROM ITCHY EYES OR SORENESS Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 21. I SUFFER FROM NAUSEA/SICKNESS Please gauge your frequency as severity as the following:10 = Very High Intense Uncomfortable Sensations0 = Feeling nothing1-2-3-4-5-6-7-8-9 = everything in between 0-10 Please select your answer 0 1 2 3 4 5 6 7 8 9 10 22. I SUFFER FROM PANIC ATTACKS Please select your answer 0 1 2 3 4 5 6 7 8 9 10 23. I AM UNWILLING TO SOCIALISE AS NORMAL Please select your answer 0 1 2 3 4 5 6 7 8 9 10 24. I'M FEELING LONELY / ISOLATED Please select your answer 0 1 2 3 4 5 6 7 8 9 10 25. I'M FEELING OVERWHELMED Please select your answer 0 1 2 3 4 5 6 7 8 9 10 26. WHAT'S THE POINT Please select your answer 0 1 2 3 4 5 6 7 8 9 10 27. I KEEP CRYING OR TEARING UP Please select your answer 0 1 2 3 4 5 6 7 8 9 10 28. I'M SO ANGRY AND FRUSTRATED Please select your answer 0 1 2 3 4 5 6 7 8 9 10 29. I FEEL LOST / CONFUSED Please select your answer 0 1 2 3 4 5 6 7 8 9 10 30. I'M FINDING IT DIFFICULT TO MAKE DECISIONS Please select your answer 0 1 2 3 4 5 6 7 8 9 10 1 out of 30 Please fill in the comment box below.
