Health, Wellness & Quality of Life Questionnaire
  1. Presence of physical pain (neck/back ache, sore arms/legs, etc.).
  2. Feeling of tension or stiffness or lack of flexibility in your spine.
  3. Incidence of fatigue or low energy.
  4. Incidence of colds and flu.
  5. Incidence of headaches (of any kind).
  6. Incidence of nausea or constipation.
  7. Incidence of menstrual discomfort.
  8. Incidence of allergies or skin rashes.
  9. Incidence of dizziness or light-headedness.
  10. Incidence of accidents or near accidents or falling or tripping.
  11. II. Mental/Emotional State
  12. If pain is present, how distressed are you about it?
  13. Presence of negative or critical feelings about your self.
  14. Experience of moodiness or temper or angry outbursts.
  15. Experience of depression or lack of interest.
  16. Being overly worried about small things.
  17. Difficulty thinking or concentrating or indecisiveness.
  18. Experience of vague fears or anxiety.
  19. Being fidgety or restless; difficulty sitting still.
  20. Difficulty falling or staying asleep.