First Name
Last Name
I found it hard to wind down
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Date
Do you have symptoms of :
Shortness of breath with exercise
Chest pain with exercise
Ankle swelling
Sob lying down
Snoring, restless sleep, feel tired in mornings, morning headaches
Chronic cough
Heartburn
Fullness in upper abdomen/left side
Painful joints
Easy bruising
Urinary difficulty - frequency, urgency, incontinence, difficulty passing urine
Rashes, ulcers, varicose veins
Change to skin thickness/darkening around fold lines
Do you suffer from or have you had the following medical complications?
Headaches or blurred vision
Stroke/TIA
High blood pressure
Heart failure
Coronary artery disease (ie: heart attack stent)
Pulmonary embolism
Obstructive sleep aponea
Asthma
Reduced exercise tolerance
Reflux
T2DM
High cholesterol or other lipid problem
Alerted liver profile
Polycystic ovarian syndrome
Irregular cycle
Infertility issues
Urinary incontinence
Depression
Body dysmorphia
Low self esteem
Addictive behaviours
Osteoarthritis
Joint and musculoskeletal injuries/pain
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