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ID
19977
Description
GLOBAL HEALING CENTER - LIVE HEALTHY|General Health Questionnaire Note — This General Health Questionnaire is not intended to diagnose, treat, cure or prevent any disease. No statements herein have been evaluated by the FDA nor is any endorsement thereof implied or given. We advise use of this Questionnaire simply as a starting point for consideration of any negative health symptoms you may be experiencing and potential preventative measures or as a resource for further discussion with your healthcare provider. http://www.globalhealingcenter.com/general-health-questionnaire.html
Link
http://www.globalhealingcenter.com/general-health-questionnaire.html
Keywords
Versions (1)
- 2/1/17 2/1/17 -
Uploaded on
February 1, 2017
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License
Creative Commons BY-NC 3.0
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GLOBAL HEALING CENTER - General Health Questionnaire
GLOBAL HEALING CENTER - General Health Questionnaire
- StudyEvent: ODM
Similar models
GLOBAL HEALING CENTER - General Health Questionnaire
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Do You Feel Basically Healthy?
Item
Do You Feel Basically Healthy?
boolean
Do You Consider Yourself Happy?
Item
Do You Consider Yourself Happy?
boolean
List any negative health symptoms you're experiencing:
Item
List any negative health symptoms you're experiencing:
text
Item Group
Do You Have Chronic Inflammation in Your Body?
Do you have elevated cholesterol or triglycerides?
Item
Do you have elevated cholesterol or triglycerides?
boolean
Do you have numbness or tingling in your arms or legs?
Item
Do you have numbness or tingling in your arms or legs?
boolean
Do you eat meat, commercially baked sweets, fried foods, or use vegetable oil daily?
Item
Do you eat meat, commercially baked sweets, fried foods, or use vegetable oil daily?
boolean
Do you consume fish less than two times per week?
Item
Do you consume fish less than two times per week?
boolean
Do you have high blood pressure, asthma, or colitis?
Item
Do you have high blood pressure, asthma, or colitis?
boolean
Do you smoke?
Item
Do you smoke?
boolean
Do you have gingivitis, periodontal disease, or not have regular dental cleansings and check-ups at least once every six months?
Item
Do you have gingivitis, periodontal disease, or not have regular dental cleansings and check-ups at least once every six months?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
boolean
Do you regularly include fast food in your diet (three or more times per week)?
Item
Do you regularly include fast food in your diet (three or more times per week)?
boolean
Do you experience belching, bloating, or persistent fullness soon after eating, or do you experience excess gas often?
Item
Do you experience belching, bloating, or persistent fullness soon after eating, or do you experience excess gas often?
boolean
Do you experience heartburn or acid reflux two or more times per week?
Item
Do you experience heartburn or acid reflux two or more times per week?
boolean
Are you allergic to any specific foods?
Item
Are you allergic to any specific foods?
boolean
Do you feel fatigued or lethargic after eating?
Item
Do you feel fatigued or lethargic after eating?
boolean
Do you commonly have bad breath or a bad taste in your mouth?
Item
Do you commonly have bad breath or a bad taste in your mouth?
boolean
Do you use digestive aids such as laxatives, antacids, or acid-blocking drugs?
Item
Do you use digestive aids such as laxatives, antacids, or acid-blocking drugs?
boolean
Do you often feel "older" than you should for your age?
Item
Do you often feel "older" than you should for your age?
boolean
Does your skin look sallow, gray, puffy, wrinkled, or aged?
Item
Does your skin look sallow, gray, puffy, wrinkled, or aged?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Do You Have Abnormal Blood Sugar Levels? Are You Pre-Diabetic or At Risk?
Does your waistline extend beyond your hips or are you overweight?
Item
Does your waistline extend beyond your hips or are you overweight?
boolean
Do you become tired or light-headed or do you feel the need to eat again just two or three hours after your last meal?
Item
Do you become tired or light-headed or do you feel the need to eat again just two or three hours after your last meal?
boolean
Do you eat dried beans e.g. pinto, navy, black, etc. less than three times per week?
Item
Do you eat dried beans e.g. pinto, navy, black, etc. less than three times per week?
boolean
Do you exercise less than three times each week?
Item
Do you exercise less than three times each week?
boolean
Do you exercise less than three times each week?
Item
Do you exercise less than three times each week?
boolean
Do you eat two or more servings of bread, pasta, candy, colas, or fruit juice a day?
Item
Do you eat two or more servings of bread, pasta, candy, colas, or fruit juice a day?
boolean
Do you eat fewer than five servings of fresh, raw vegetables and fruits per day?
Item
Do you eat fewer than five servings of fresh, raw vegetables and fruits per day?
boolean
Do you have high blood triglyceride levels or suffer from hypertension?
Item
Do you have high blood triglyceride levels or suffer from hypertension?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Do You Have Impaired Cellular/Mitochondrial Function?
Are you frequently tired for no reason (especially around 3 P.M.)?
Item
Are you frequently tired for no reason (especially around 3 P.M.)?
boolean
Do you have stiff and sore muscles (unrelated to recent exercise)?
Item
Do you have stiff and sore muscles (unrelated to recent exercise)?
boolean
Do you have poor stamina, shortness of breath, or feel exhausted after exercising?
Item
Do you have poor stamina, shortness of breath, or feel exhausted after exercising?
boolean
Do you exercise less than two hours per week?
Item
Do you exercise less than two hours per week?
boolean
Have you ever been diagnosed with iron deficiency or do you have heavy menses?
Item
Have you ever been diagnosed with iron deficiency or do you have heavy menses?
boolean
Do you look older than your true age?
Item
Do you look older than your true age?
boolean
Have you ever been exposed to toxic chemicals or heavy metals?
Item
Have you ever been exposed to toxic chemicals or heavy metals?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Is Your Detoxification Capacity Impaired?
Do you become physically ill when exposed to strong smells (perfume, auto-exhaust, cigarette smoke, etc.)?
Item
Do you become physically ill when exposed to strong smells (perfume, auto-exhaust, cigarette smoke, etc.)?
boolean
Do you use chemical cleaners or solvents at home, at work, or in your hobbies?
Item
Do you use chemical cleaners or solvents at home, at work, or in your hobbies?
boolean
Do you live in a house/apartment or work in an office less than 5 years old?
Item
Do you live in a house/apartment or work in an office less than 5 years old?
boolean
Do you have any amalgam (mercury) dental fillings?
Item
Do you have any amalgam (mercury) dental fillings?
boolean
Are you prone to side effects from medications or supplements, or have you become more sensitive to the effects of alcohol or caffeine (reduced tolerance)?
Item
Are you prone to side effects from medications or supplements, or have you become more sensitive to the effects of alcohol or caffeine (reduced tolerance)?
boolean
Do you have fewer than 2 bowel movements daily?
Item
Do you have fewer than 2 bowel movements daily?
boolean
Do you smoke?
Item
Do you smoke?
boolean
Do you have or have you ever had breast implants?
Item
Do you have or have you ever had breast implants?
boolean
Do you have any pets, especially dogs, cats, birds, or other furred or feathered animals?
Item
Do you have any pets, especially dogs, cats, birds, or other furred or feathered animals?
boolean
Do you wake up often during the night to urinate?
Item
Do you wake up often during the night to urinate?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Do you have carpet in your home?
Item
Do you have carpet in your home?
boolean
Do you vacuum less than 3 times per week?
Item
Do you vacuum less than 3 times per week?
boolean
Have you changed or cleaned your air filters in the last 30 days?
Item
Have you changed or cleaned your air filters in the last 30 days?
boolean
Do you routinely drink tap water?
Item
Do you routinely drink tap water?
boolean
Are your clothes and bedding washed in unfiltered city water?
Item
Are your clothes and bedding washed in unfiltered city water?
boolean
Have you recently repainted your home on the inside?
Item
Have you recently repainted your home on the inside?
boolean
Have you noticed any black spots or mold on your air vents or walls?
Item
Have you noticed any black spots or mold on your air vents or walls?
boolean
Have you had your air vents cleaned in the past year?
Item
Have you had your air vents cleaned in the past year?
boolean
Do you use chemical based cleaners in your home?
Item
Do you use chemical based cleaners in your home?
boolean
Do you use chemical fertilizers, insecticides, or pesticides?
Item
Do you use chemical fertilizers, insecticides, or pesticides?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
What is the Quality of Your Immune System Function?
Do you catch colds or the flu easily?
Item
Do you catch colds or the flu easily?
boolean
Do colds, flu, or other infections tend to linger in your system more than 5 days?
Item
Do colds, flu, or other infections tend to linger in your system more than 5 days?
boolean
Do you have a chronic cough, scratchy throat, sinus congestion, or excess mucous production making it necessary to clear your throat often?
Item
Do you have a chronic cough, scratchy throat, sinus congestion, or excess mucous production making it necessary to clear your throat often?
boolean
Do you have seasonal allergies or known allergies to dust, animals, or mold?
Item
Do you have seasonal allergies or known allergies to dust, animals, or mold?
boolean
Have you ever been diagnosed with an autoimmune disease?
Item
Have you ever been diagnosed with an autoimmune disease?
boolean
Do you have dark circles under your eyes?
Item
Do you have dark circles under your eyes?
boolean
Do you have difficulty seeing at night, or do you have white spots on your fingernails?
Item
Do you have difficulty seeing at night, or do you have white spots on your fingernails?
boolean
Have you recently had any vaccinations?
Item
Have you recently had any vaccinations?
boolean
Have you or anyone in your family served in the military in the last 15 to 20 years?
Item
Have you or anyone in your family served in the military in the last 15 to 20 years?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Do you feel angry from time to time?
Item
Do you feel angry from time to time?
boolean
Are you agitated easily?
Item
Are you agitated easily?
boolean
Do you have frequent mood swings?
Item
Do you have frequent mood swings?
boolean
Is it hard to stay in a good mood?
Item
Is it hard to stay in a good mood?
boolean
Do you run out of energy during the day?
Item
Do you run out of energy during the day?
boolean
Do you have brown spots on your skin or age spots?
Item
Do you have brown spots on your skin or age spots?
boolean
Does your skin break out or is it blemished?
Item
Does your skin break out or is it blemished?
boolean
Are your emotions often on a "roller coaster"?
Item
Are your emotions often on a "roller coaster"?
boolean
Do you later have to apologize for your bad moods to friends, family, co-workers, etc.?
Item
Do you later have to apologize for your bad moods to friends, family, co-workers, etc.?
boolean
Is there always "something wrong" in your life?
Item
Is there always "something wrong" in your life?
boolean
Have you ever been physically or sexually abused?
Item
Have you ever been physically or sexually abused?
boolean
If you are upset, is it best not to talk to you about what's going on?
Item
If you are upset, is it best not to talk to you about what's going on?
boolean
Do you get annoyed by the "fake" cheeriness of others?
Item
Do you get annoyed by the "fake" cheeriness of others?
boolean
Do these questions irritate you?
Item
Do these questions irritate you?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Are Your Kidney and Urinary Systems Functioning Properly?
Do you have pain in your muscles and joints?
Item
Do you have pain in your muscles and joints?
boolean
Have you had kidney or bladder infections in the last year?
Item
Have you had kidney or bladder infections in the last year?
boolean
Have you experienced ankle pain or swelling in the last year?
Item
Have you experienced ankle pain or swelling in the last year?
boolean
Do you have left shoulder pain?
Item
Do you have left shoulder pain?
boolean
Do your fingernails chip or break easily?
Item
Do your fingernails chip or break easily?
boolean
Do you have puffiness, "bags", or dark circles under your eyes?
Item
Do you have puffiness, "bags", or dark circles under your eyes?
boolean
Is your hair thinning?
Item
Is your hair thinning?
boolean
Do you have frequent scalp irritations?
Item
Do you have frequent scalp irritations?
boolean
Do you have painful, harsh menstrual cycles?
Item
Do you have painful, harsh menstrual cycles?
boolean
Do you wake up often during the night to urinate?
Item
Do you wake up often during the night to urinate?
boolean
Do you feel exhausted in the morning even after sleeping 8 or more hours?
Item
Do you feel exhausted in the morning even after sleeping 8 or more hours?
boolean
Have you ever been diagnosed with thyroid problems?
Item
Have you ever been diagnosed with thyroid problems?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Do You Have Parasites, Viruses, Fungi, or other Microbes Inside Your Body?
Do you have any yellowish discoloration on your fingernails or toenails?
Item
Do you have any yellowish discoloration on your fingernails or toenails?
boolean
Do you have athlete's foot or noticeable foot odor?
Item
Do you have athlete's foot or noticeable foot odor?
boolean
Do you have a history of yeast infections?
Item
Do you have a history of yeast infections?
boolean
Have you been "mouthed", scratched, or licked by an animal in the last 6 months?
Item
Have you been "mouthed", scratched, or licked by an animal in the last 6 months?
boolean
Have you been bitten by mosquitoes or bugs?
Item
Have you been bitten by mosquitoes or bugs?
boolean
Do you feel bloated, grumpy, or gassy after meals?
Item
Do you feel bloated, grumpy, or gassy after meals?
boolean
Have you eaten at a sushi bar, salad bar, or buffet recently?
Item
Have you eaten at a sushi bar, salad bar, or buffet recently?
boolean
Have you ever picked food up off the floor and eaten it?
Item
Have you ever picked food up off the floor and eaten it?
boolean
Do you often crave sugar, sweets, or bread?
Item
Do you often crave sugar, sweets, or bread?
boolean
Do you experience anal itching?
Item
Do you experience anal itching?
boolean
Do you have dandruff?
Item
Do you have dandruff?
boolean
Do you have indoor pets?
Item
Do you have indoor pets?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Are Your Adrenal Glands Functioning Properly?
Do you frequently feel "stressed out"?
Item
Do you frequently feel "stressed out"?
boolean
Do you have difficulty falling asleep or maintaining sleep through the night?
Item
Do you have difficulty falling asleep or maintaining sleep through the night?
boolean
Do sudden noises make you jump?
Item
Do sudden noises make you jump?
boolean
Do you become dizzy or light-headed when standing up too quickly?
Item
Do you become dizzy or light-headed when standing up too quickly?
boolean
Do you crave salt or sugar?
Item
Do you crave salt or sugar?
boolean
Do you drink coffee?
Item
Do you drink coffee?
boolean
Have you taken any diet pills in the last 3 years?
Item
Have you taken any diet pills in the last 3 years?
boolean
Do you drink any highly caffeinated beverages such as soft drinks or energy drinks?
Item
Do you drink any highly caffeinated beverages such as soft drinks or energy drinks?
boolean
Do you exercise less than 3 times per week?
Item
Do you exercise less than 3 times per week?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Are you frequently cold or do you have cold hands and feet?
Item
Are you frequently cold or do you have cold hands and feet?
boolean
Do you have trouble "getting going" in the morning?
Item
Do you have trouble "getting going" in the morning?
boolean
Do you often feel sad or depressed, especially in the morning?
Item
Do you often feel sad or depressed, especially in the morning?
boolean
Are you unable to lose weight despite improving your diet and exercising more?
Item
Are you unable to lose weight despite improving your diet and exercising more?
text
Do you have diffused or "patches" of hair loss from your head, arms, or legs?
Item
Do you have diffused or "patches" of hair loss from your head, arms, or legs?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Item Group
Are Your Sex Hormones Reduced in Production or Quality?
Are you "flabby" or have you experienced a loss of muscle tone?
Item
Are you "flabby" or have you experienced a loss of muscle tone?
boolean
Do you suffer from a low sex drive?
Item
Do you suffer from a low sex drive?
boolean
Do you frequently experience headaches or migraines?
Item
Do you frequently experience headaches or migraines?
boolean
Do you have Pre-Menstrual Syndrome (PMS)?
Item
Do you have Pre-Menstrual Syndrome (PMS)?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Are you very easily fatigued?
Item
Are you very easily fatigued?
boolean
Do you suffer from Pre-Menstrual Syndrome (PMS)?
Item
Do you suffer from Pre-Menstrual Syndrome (PMS)?
boolean
Do you have painful menses (periods)?
Item
Do you have painful menses (periods)?
boolean
Do you frequently experience depression before or during menstruation?
Item
Do you frequently experience depression before or during menstruation?
boolean
Is your menstrual cycle prolonged in duration or excessive in terms of blood flow?
Item
Is your menstrual cycle prolonged in duration or excessive in terms of blood flow?
boolean
Are your breasts overly sensitive or "painful" before, during, or after menses?
Item
Are your breasts overly sensitive or "painful" before, during, or after menses?
boolean
Do you menstruate too frequently (more than once per month or sporadic flow)?
Item
Do you menstruate too frequently (more than once per month or sporadic flow)?
boolean
Do you produce a vaginal discharge?
Item
Do you produce a vaginal discharge?
boolean
Have you had a hysterectomy or had your ovaries removed?
Item
Have you had a hysterectomy or had your ovaries removed?
boolean
Do you have menopausal "hot flashes"?
Item
Do you have menopausal "hot flashes"?
boolean
Is your menses irregular or absent altogether?
Item
Is your menses irregular or absent altogether?
boolean
Do you have acne or other skin blemishes that worsen during menses?
Item
Do you have acne or other skin blemishes that worsen during menses?
boolean
Have you felt depressed for 3 months or longer?
Item
Have you felt depressed for 3 months or longer?
boolean
Do you have hair growth on your face or body?
Item
Do you have hair growth on your face or body?
boolean
Do you have or desire sex less than 2 times each month?
Item
Do you have or desire sex less than 2 times each month?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
Are you very easily fatigued?
Item
Are you very easily fatigued?
boolean
Do you have premature ejaculation?
Item
Do you have premature ejaculation?
boolean
Is urination difficult or do you "dribble" i.e. can't stop completely?
Item
Is urination difficult or do you "dribble" i.e. can't stop completely?
boolean
Have you experienced or are you experiencing prostate trouble?
Item
Have you experienced or are you experiencing prostate trouble?
boolean
Do you often wake up during the night to urinate?
Item
Do you often wake up during the night to urinate?
boolean
Do you have pain on the inside of your legs or heels?
Item
Do you have pain on the inside of your legs or heels?
boolean
Do you have feelings of incomplete bowel evacuation or "not emptying fully"?
Item
Do you have feelings of incomplete bowel evacuation or "not emptying fully"?
boolean
Do you have problems sleeping?
Item
Do you have problems sleeping?
boolean
Do you avoid even routine or mild physical activity?
Item
Do you avoid even routine or mild physical activity?
boolean
Do you run out of energy during the day?
Item
Do you run out of energy during the day?
boolean
Do you experience leg nervousness or "twitching" at night?
Item
Do you experience leg nervousness or "twitching" at night?
boolean
Do you have difficulty falling asleep or maintaining sleep through the night?
Item
Do you have difficulty falling asleep or maintaining sleep through the night?
boolean
Have you felt depressed for 3 months or longer?
Item
Have you felt depressed for 3 months or longer?
boolean
Do you have or desire sex less than 2 times each month?
Item
Do you have or desire sex less than 2 times each month?
boolean
What is your score? Add up the number of "YES" responses.
Item
What is your score? Add up the number of "YES" responses.
integer
What is your score? Add up the number of "NO" responses.
Item
What is your score? Add up the number of "NO" responses.
integer
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