Health Check Quiz | Health Assessment by Dr. Rashel Tahzib

Health Assessment Quiz

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Name*

First Last

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The Questions - Digestive Tract

Heartburn?*

Nausea or Vomiting*

Constipation*

Diarrhea*

Bloating*

Gas*

Stomach Pain*

The Questions - Head and Neck

Itchy Ears*

Ringing in Ears*

Ear Infections*

Itchy Watery Eyes*

Bags or dark circles under eyes*

Frequent need to clear throat*

Coated, swollen or discolored Tongue*

Canker Sores*

Stuffy Nose*

Sinus Problems*

Mucous Formation, post nasal drip*

Headaches*

Dizziness*

The Questions - Lungs

Chest Congestion*

Asthma, Bronchitis*

The Questions - Heart

Irregular, Rapid or Skipped Heart Beat*

Chest pains*

The Questions - Energy

Restless or Hyperactivity*

Fatigue or Sluggish*

The Questions - Mind

Poor Concentration*

Difficulty Making Decisions*

Poor Memory*

Stuttering*

The Questions - Mood

Mood Swings*

Anxiety, fear or nervousness*

Anger, Irritability, Aggressiveness*

Depression*

The Questions - Skin

Acne*

Hives, rashes, Dry Skin*

Hair Loss*

Hot Flashes*

The Questions - Weight

Binge Eating or drinking*

Craving certain foods*

Compulsive Eating*

Water Retention*

Excessive Weight*

The Questions - Other

Frequent Illness*

Genital Itch or Discharge*

Finally

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