form

Questionnaire

Q1.What is your age? Select an option Above 40 18-40

Q2.What is your BMI? Select an option More than 30 Less than 30

Q3.Have you ever been diagnosed with any medical conditions? Select an option Yes No

Q4.Gender at Birth? Select an option Female Male

Q5.Do you want to lose weight? Select an option Yes No

Q6.Have you ever been diagnosed with any of the following conditions listed below? (Choose all that apply) Select an option Yes No

Menopause Low testosterone Thyroid disease Diabetes Low cortisol High cortisol Adrenal dysfunction or insufficiency

Q7.Do you currently have any of the following symptoms listed below? (Choose all that apply) Select an option Yes No

Hot flushes Weight gain Intolerance to carbohydrates Fluid retention Hair loss Anxiety Depression Prolonged or excessive stress Fatigue Brain Fog

Q8. Do you have any of the following Autoimmune conditions listed below? (Choose all that apply) Select an option Yes No

Rheumatoid arthritis Lupus Fibromyalgia Multiple sclerosis Type 1 diabetes Inflammatory bowel disease (IBD) Psoriasis Graves' disease Hashimoto's thyroiditis Myasthenia gravis Sjogren's syndrome Guillain-Barre syndrome Pernicious anemia Celiac disease Vitiligo Polymyalgia rheumatica Ankylosing spondylitis Autoimmune hepatitis Goodpasture's syndrome Wegener's granulomatosis Takayasu arteritis Temporal arteritis Antiphospholipid syndrome Behcet's disease Myositis Mixed connective tissue disease Reactive arthritis Scleroderma Vasculitis Addison's disease

Q9.Do you have any of the following Allergic conditions listed below? (Choose all that apply) Select an option Yes No

Allergic rhinitis (hay fever) Asthma Anaphylaxis Eczema Hives Food allergies Drug allergies Insect sting allergies Contact dermatitis Allergic conjunctivitis

Latex allergy Occupational allergies Oral allergy syndrome Exercise-induced anaphylaxis Cold-induced urticaria

Q10.Do you have any of the following Inflammatory conditions listed below? (Choose all that apply) Select an option Yes No

Gout Obesity Fatty liver disease Chronic fatigue syndrome A chronic viral illness Type 2 diabetes Insulin resistance Depression Anxiety A psychiatric condition Peri-menopause or menopause Chronic obstructive pulmonary disease Chronic bronchitis Dermatitis (Eczema) Sarcoidosis Chronic kidney disease Hepatitis

Q11.Do you currently have any of the Autoimmune symptoms listed below? (Choose all that apply) Select an option Yes No

Fatigue or exhaustion Joint pain or swelling Muscle pain or weakness Fluid retention Skin rash or hives Sensitivity to sunlight or other environmental factors Digestive problems, such as abdominal pain, diarrhoea, or constipation Numbness or tingling in the hands or feet Hair loss or thinning Swelling in the legs, feet, or hands Dry mouth or eyes Difficulty concentrating or thinking clearly

Q12.Do you currently have any of the Allergic symptoms listed below? (Choose all that apply) Select an option Yes No

Sneezing, runny or stuffy nose, and nasal congestion Itchy or watery eyes, redness or swelling of the eyes Skin rash, hives or eczema Itching or tingling in the mouth, throat, or skin Swelling of the face, lips, tongue, or throat Wheezing, coughing, or difficulty breathing Abdominal pain, diarrhoea, or vomiting Anaphylaxis, which is a severe and potentially life-threatening allergic reaction that can involve difficulty breathing, low blood pressure, and loss of consciousness

Q13.Do you currently have any of the Inflammatory symptoms listed below? (Choose all that apply) Select an option Yes No

Resistance to weight loss Food intolerances Carbohydrate intolerance Brain fog or mood changes after eating certain foods Fluctuating energy levels Shaky between meals Cravings Binge-eating

Q14.Do you have any of the following dietary restrictions? Select an option No Vegan Vegetarian

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