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1) Do you miss breakfast or other meals?
YesNo

2) Could you do with more energy?
YesNo

3) Do you get less than 7hrs sleep?
YesNo

4) Do you drink more than 3 cups of coffee a day?
YesNo

5) Do you drink more than 4 units of alcohol per week?
YesNo

6) Could you eat more fruit and veg?
YesNo

7) Do you suffer from headaches or aches & pains?
YesNo

8) Do you exercise less than 2 hours per week?
YesNo

9) Are you a worrier?
YesNo

10) Do you get irritable?
YesNo

11) Do you get depressed?
YesNo

12) Did you have any unhappiness in childhood?
YesNo

13) Have you had any major emotional upsets?
YesNo

14) Do you lack interest in sex?
YesNo

15) Do you need to learn how to relax?
YesNo

16) Do you need to improve your relationship(s)?
YesNo

17) Would you like a new job?
YesNo

18) Could you do with a holiday?
YesNo

19) Do you suffer with frequent infections or poor digestion?
YesNo

20) Are you on medication?
YesNo

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