Personal Health Assessment

Male Female

Office / Desk job Teacher / Healthcare / Social work Physical / Manual labor Stay-at-home parent Shift / Night shift work Student Retired / Semi-retired Business owner / Freelancer Other

Acid reflux / Heartburn Frequent belching / Bloating Stomach pain / Gastric discomfort Slow digestion / Post-meal bloating Poor appetite / Loss of appetite Frequent abdominal bloating / Gas Constipation (less than every 2 days) Loose stools / Diarrhea Irregular bowel movements (alternating hard and loose) Sticky stools / Mucus in stool No significant issues

Frequent colds / Recurring infections / Low immunity Allergic rhinitis / Seasonal allergies Skin allergies / Eczema / Hives Chronic inflammation (pharyngitis / gastritis / pelvic inflammatory disease, etc.) Frequent mouth ulcers / Oral inflammation Chronic pain with inflammation (swollen joints / gout attacks, etc.) Autoimmune conditions (hyperthyroidism / hypothyroidism / rheumatoid arthritis / lupus, etc.) No significant issues

Continuous weight gain / Difficulty controlling weight Difficulty losing weight (even with dieting) Excess abdominal fat / Belly fat High blood lipids (elevated triglycerides or cholesterol) Elevated blood sugar / Abnormal fasting glucose Insulin resistance / Type 2 diabetes Post-meal fatigue / Noticeable blood sugar fluctuations Frequent intense hunger / Sugar cravings No significant issues

Difficulty falling asleep (takes more than 30 minutes) Waking up early / Waking during the night Still tired after waking / Unrefreshing sleep Chronic anxiety / High stress Poor concentration / Memory decline Daytime drowsiness / Low energy Low mood / Depressive feelings No significant issues

High blood pressure / Hypertension Chest tightness / Occasional chest pain Heart palpitations / Irregular heartbeat Frequent dizziness / Headaches Tinnitus / Ringing in ears Cold or numb hands / feet Leg / ankle swelling Atherosclerosis / Carotid plaque (diagnosed) No significant issues

Neck discomfort / Cervical spondylosis Shoulder / neck stiffness Lower back pain / Lumbar ache Knee discomfort / Joint pain Morning stiffness (joint stiffness >30 min after waking) Back pain after prolonged sitting Frequent muscle cramps Low bone density / Osteoporosis Slow recovery after exercise (joints or muscles) No significant issues

Dry eyes Eye strain / Visual fatigue Screen use more than 8 hours per day Floaters Declining vision / Worsening myopia Migraines / Head pressure Brain fog / Cognitive slowness / Slower reaction time No significant issues

Dull complexion / Sallow skin Age spots / Hyperpigmentation Tendency to retain water / Puffiness Loss of collagen / Skin laxity Menopausal symptoms (hot flashes / night sweats) Irregular periods / Abnormal flow / Dysmenorrhea Hormonal mood swings / Irritability Hair loss (hormone-related) Vaginal dryness / Decreased libido No significant issues

Pregnancy fatigue / Morning sickness Pregnancy anemia Pregnancy edema Poor sleep during pregnancy Postpartum fatigue / Slow recovery Postpartum hair loss Difficulty losing postpartum weight Currently breastfeeding No significant issues

Significant energy decline / Possible low testosterone Muscle loss / Decreased strength Hair loss / Receding hairline Accelerated skin aging / Loss of radiance Increased abdominal fat (beer belly) Low mood / Irritability / Increased restlessness Significantly slower recovery after exercise Decreased sexual function / Concerns about sexual health Prostate discomfort (frequent urination / nocturia / weak urinary stream) Low testosterone (confirmed by test results) No significant issues

High blood pressure (SBP ≥ 140 mmHg) High uric acid / Gout history Fatty liver (mild / moderate / severe) Anemia / Low hemoglobin Low Vitamin D Thyroid nodule / Thyroid dysfunction (hyperthyroidism / hypothyroidism) Breast nodule / Fibrocystic changes Gastric polyps / Intestinal polyps Pulmonary nodule (requires follow-up) Prostate enlargement / Elevated PSA Carotid plaque / Atherosclerosis Elevated tumor markers (CEA / CA125 / AFP / CA199, etc.) Other abnormalities No abnormalities found

No major illness history Cancer / Malignancy (breast / colorectal / lung / thyroid / cervical / liver / stomach / prostate / other) Heart disease / Heart attack / Stent or bypass surgery Cerebral infarction / Stroke Type 2 Diabetes Chronic kidney disease / Renal insufficiency Autoimmune disease (lupus / ankylosing spondylitis / Crohn's disease, etc.) Severe depression / Bipolar disorder Organ transplant (requires long-term anti-rejection medication) Other major illness

No ongoing treatments Currently undergoing chemotherapy Currently undergoing radiation therapy Immunotherapy / Targeted therapy Long-term anticoagulants (Warfarin / Rivaroxaban / Aspirin, etc.) Long-term oral corticosteroids (Prednisone, etc.) Thyroid hormone replacement or anti-thyroid medication Blood sugar medication / Insulin Statin medications Cardiac medications (beta-blockers / ACE inhibitors / ARBs, etc.) Other long-term prescription medications

No significant family history Cancer (any type) Heart disease / Heart attack Diabetes Hypertension Stroke Osteoporosis Thyroid disease Autoimmune disease Dementia / Alzheimer's disease

Frequent takeout / fast food High-fat / greasy diet Sweet tooth / High sugar intake Frequent late-night eating Light / Low-fat diet Low water intake (less than 1.5L per day) Rarely eat fruits or vegetables Frequent late nights (sleep after midnight) Consistently high work stress Occasional smoking Daily smoking Rarely drink alcohol Drink alcohol 1–2 times per week Frequent social drinking / Heavy alcohol consumption Occasional coffee / energy drinks (a few times per week) Daily coffee / energy drinks

Rarely exercise 1–2 times per week (20+ minutes each session) 3+ times per week (regular exercise)

Fish oil / Omega-3 Multivitamin Vitamin D Vitamin C B-complex vitamins Magnesium Zinc Iron Folate / Folic acid Probiotics Dietary fiber / Fiber supplement Collagen Protein powder Lutein Coenzyme Q10 Other Not taking any supplements