Developing a Drug-Free Health Management System Since 1979
Take this Survey to Discover Important Health Information About Yourself
Are you tired and sluggish by mid-day?
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Yes
No
Do you feel less than your best--older than you should?
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Yes
No
Are you irritated easily?
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Yes
No
Do you have difficulty sleeping?
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Yes
No
Do you skip activities because you don't have the energy to participate?
*
Yes
No
Do you wish you felt the way you did 20 years ago?
*
Yes
No
Are you anxious or nervous daily?
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Yes
No
Do you forget information, names and items?
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Yes
No
Do you find it difficult to be alert?
*
Yes
No
Do you cry or experience sadness often?
*
Yes
No
Do you wish you could think more clearly?
*
Yes
No
Do you eat less than seven servings of fresh fruit and vegetables each day?
*
Yes
No
Do you worry often?
*
Yes
No
Are you under stress at work or home?
*
Yes
No
Do you find it hard to concentrate?
*
Yes
No
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