SWI: HGH HORMONE BALANCING TEST

HGH HORMONE BALANCING TEST

Name:

Birth of date: Month / Day / Year

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Questionnaire

PLEASE TAKE A MOMENT TO COMPLETE THE FOLLOWING QUESTIONS


1. Do you often feel tired? Yes No


2. Do you feel happy most of the time? Yes No


3. Do you often go through mood swings? Yes No


4. Do you get angry easily? Yes No


5. Are you depressed often? Yes No


6. Do you feel anxious or stressed out? Yes No


7. Do you feel you work to hard? Yes No


8. Do you look forward to retirement? Yes No


9. Do you keep in touch with friends? Yes No


10. Do you maintain interest in sex? Yes No


11. Is your sex life decling? Yes No


12. Do you have trouble falling or staying asleep? Yes No


13. Do you feel rested after you sleep? Yes No


14. Do you find your self forgetting things? Yes No


15. Do you find it hard to think clearly? Yes No


16. Do you use memory aids? Yes No


17. Do you have problems concentrating? Yes No


18. Are you in poor physical shape? Yes No


19. Are you more than 20% above your ideal weight? Yes No


20. Is it very difficult to you to lose weight? Yes No


21. Have you developed a spare tire or love handles? Yes No


22. Does your musculature look youthful? Yes No


23. Do you feel your overall health is good? Yes No


24. Do you often get cold or feel sick? Yes No


25. Do you commonly feel aches or pains? Yes No


26. Is your blood cholesterol over 200? Yes No


27. Is your blood cholesterol over 240? Yes No


28. Men - is your HDL less then 45? Yes No


29. Women - is your HDL less then 55? Yes No


30. Is your blood pressure normal? Yes No


31. Has your vision noticeably deteriorated? Yes No


32. Do you have frequent urination? Yes No


33. Do you have digestive problems? Yes No


34. Does the skin on your face, neck, upper arms, and abdomen appear to hang? Yes No


35. Do you think you look older than your age mates? Yes No


36. Do you need hair cut less frequently? Yes No


37. Does it seem to take a long time for cuts and bruises to heal and for wounds to close? Yes No


38. Is it getting harder to exercise? Yes No


39. Do you seem to have less strength for gripping or lifting? Yes No


40. Is your endurance less? Yes No


41. Is your breathing more labored when you exercise hard? Yes No


42. Do you ding the longer you live the better you feel about life? Yes No


43. Are you 45 to 54? Yes No


44. Are you 55 to 64? Yes No


45. Are you 65 or above? Yes No