My Healthiness Score QOL Health Wizard Wanna measure your Healthiness? Check your Health impact by filling this form. Undergoing any treatment? Assess your outcomes by filling this form before starting your treatment and then at every 4 weeks during the treatment to know how you are doing with the treatment. You can also fill this form, twice a year, just to keep a check! Startpress Enter Your Unique ID Your Full Name * Your Full Name First First Last Last Date of Birth * Your Gender Identity * Female Male Transgender OtherOther Your Age Group * Under 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to Answer List the medical conditions you are suffering with * List the medicines prescribed by your doctor which you take * Which approach do you take for your conditions? * Conventional / AllopathyHomeopathicNaturopathicIntegrative or MixedTherapy like counselling, psychotherapy, art, etcProcedural like acupuncture, osteopathic, cupping, etcOther Which approach do you take for your conditions? List the medicines you take by yourself for your conditions * In general, how would you say your health is * Excellent Very Good Good Fair Poor Compared to one year ago, how would you rate your health in general now? * Much better now than one year ago Some what better now than one year ago About the same Some what worse now than one year ago Much worse now than one year ago Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports due to my physical health are * Limited a lot Limited a little Not limited at all Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf due to my physical health are * Limited a lot Limited a little Not limited at all Lifting or carrying groceries due to my physical health are * Limited a lot Limited a little Not limited at all Climbing several flights of stairs due to my physical health are * Limited a lot Limited a little Not limited at all Climbing one flight of stairs due to my physical health is * Limited a lot Limited a little Not limited at all Bending, kneeling, or stooping due to my physical health is * Limited a lot Limited a little Not limited at all Walking more than, a mile or 1.609 km due to my physical health is * Limited a lot Limited a little Not limited at all Walking several blocks or 500 meters or 0.31 miles due to my physical health is * Limited a lot Limited a little Not limited at all Walking one block or 100 meters or 315 feet due to my physical health is * Limited a lot Limited a little Not limited at all Bathing or dressing myself due to my physical health is * Limited a lot Limited a little Not limited at all In the past 4 weeks, have you had to cut down the amount of time you spent on work or other activities due to your physical health problems? * Yes No In the past 4 weeks, were you able to accomplish less than you would like due to your physical health problems? * Yes No In the past 4 weeks, were you limited in the kind of work or other activities due to your physical health problems? * Yes No In the past 4 weeks, did you have difficulty performing the work or other activities for example it took extra effort than usual due to your physical health problems? * Yes No In the past 4 weeks, have you had to cut down the amount of time you spent on work or other activities, due to emotional problems? * Yes No In the past 4 weeks, were you able to accomplish less than you would like, due to emotional problems? * Yes No In the past 4 weeks, didn't do work or other activities as carefully as usual, due to emotional problems? * Yes No If you are human, leave this field blank. ContinueCalculate my score Use Shift+Tab to go back