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17

Do you smoke?

Yes No

16

Do you drink alcohol?

Yes No

15

Do you often encounter stressful situations?

Yes No

14

Do you have any relatives in your family who have suffered from cardiovascular diseases?

Yes No

13

How often do you include sweets, fast food, fatty and fried foods in your diet?

Yes No

12

Do you often eat on the go or dry, quickly swallowing your food?

Yes No

11

Do you often go to bed after 11 PM?

Yes No

10

Do you ever experience insomnia or restless sleep?

Yes No

9

Do you ever have high blood pressure?

Yes No

8

Do you have extra weight?

Yes No

7

Do you have any diagnosed nutrient deficiencies (vitamins, minerals)?

Yes No

6

Do you take medications on a regular basis (or often)?

Yes No

5

Do you often have severe headaches?

Yes No

4

Do you ever experience numbness in your limbs?

Yes No

3

Do you experience swelling in your face or limbs?

Yes No

2

Do you experience symptoms of hemorrhoids?

Yes No

1

Do you have spider veins on your legs or face?

Yes No