Health Assessment

1 = DISAGREE / 5 = AGREE

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Name

Which programme are you enroled in?

Tired most of the time

Poor memory or concentration

Often stressed or anxious

Difficulty sleeping

Low mood or depressed

Prone to indigestion/bloating after meals

Feeling puffy or inflamed

Prone to mood swings

Crave something sweet after meals

Gaining weight / difficulty losing weight

Energy slumps during the day / after meals

Frequent cravings for sugar or carbs