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| 1) What are your top personal concerns? |
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| 2) How healthy is your lifestyle? |
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| 3) Rate in order of priority the environment in and around your home on each of these. |
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| 4) Rate the environment at your workplace on each of these. |
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| 5) How many times have you been ill in the past one year? |
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| 6) How often do you and your partner go in for a routine check-up without a complaint? |
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| 7) Do you have health insurance? |
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| 8) Rate these niggling health problems on their occurrence. |
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| 9) Rate in order of priority. |
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| 10) Do you smoke? |
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| 11) Do you drink alcohol? |
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| 12) When you have a health problem, your immediate first step is to |
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| 13) When you go to a doctor |
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| 14) How often do you exercise every week? |
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| 15) Which of the following do you do at least thrice a week? |
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| 16) You exercise to |
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| 17) When not feeling well you would rather |
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| 18) Which streams of alternative medicines/ therapies have you tried? |
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| 19) Which stream would you rely on the most? |
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| 20) Which of the following have you experienced? |
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| 21) Which of these would you want to change |
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| 22) Have you ever tried a specific, recommended diet? |
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| 23) Which of the items listed below do you include in your meals? |
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| 24) How often do you visit a beauty parlour? |
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| 25) Which of these have you tried? |
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| 26) What do you do for stress busting? |
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| 27) Your priorities for the future |
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