Online Checkup Form

Choose your gender
Please indicate your age
Please indicate your age
Do you smoke often?
Did your next of kin ever have colorectal cancer?
Did your next of kin ever have heart disease and vascular disease?
Do you drink often?
Did your next of kin ever have diabetes?
Do you smoke often? Or did your next of kin ever have lung cancer?
In the past year, you had sexual intercourse. Did you not have cervical cancer examination?
In the past year, did you have breast cancer examination?
Did your next of kin ever have heart disease and vascular disease?
Did your next of kin ever have colorectal cancer?
Do any members of your family have had skin cancer?
Do any members of your family have a history of allergy?
Have you ever had any of the following symptoms?
  1. Feeling weak and frail
  2. Metabolism is ineffective; easily lose and gain weight
  3. Change of skin texture: dry, wrinkled and decreasing muscle mass
  4. Sleeping disorders: difficulty in maintaining sleep; snatch of sleep
  5. Easily irritated; depressed; low sex drive
Would you like to know the levels of vitamins and antioxidants in your system to strengthen your body and make you stay lively all day?
Are you in these situations --- stay up late at night, experience high stress, and eat processed and instant foods often?
Do you feel exhausted and sleepy despite sleeping for 6-8 hours a night?
Do you exercise for more than 30 minutes and more than 3 times a week?
Do you work in an area where loud noises persist for hours?
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