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Functional Medicine
Longevity
- Longevity Consult
- Biological Age Longevity Test
Functional Lab
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About
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- Testimonials
- Contact
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  - Counsellors
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Take Our Health Quiz

Health Assessment

Take Charge Of Your Health

Take A Free Health Assessment Now!

Your well-being is important. Stress, pollution, poor nutrition and other factors can take a toll on your health, making it difficult to concentrate or perform at your best. We guide you through an over-arching holistic review of body system that identifies the cause of your health concerns and helps direct you to optimal wellness.

We invite you to take our free health assessment and get your personalised health score.

Save and Continue Later

INSTRUCTIONS:

This form has a list of symptoms that you may or may not experience:

1. Rate each of them on a scale of 1-4 using the guidance below.

2. Based the rating for your typical health profile on how it's been over the past 24 hours.

* Each question requires a response. Select "Zero" if you do not have this symptom.
Symptom Example
- 0: Never or almost never have the symptom
- 1: Occasionally have it, effect is not severe
- 2: Occasionally have it, effect is severe
- 3: Frequently have it, effect is not severe
- 4: Frequently have it, effect is severe

Save and Continue Later

Name*
First Last
Email*
Phone*
I would like to receive newsletters
- I would like to receive newsletters

Save and Continue Later

Head
Headaches*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Faintness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Dizziness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Insomnia*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Eyes
Watery or itchy eyes*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Swollen, reddened or sticky eyelids*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Bags or dark circles under eyes*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Blurred or tunnel vision (Does not include near or far-sightedness)*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Ears
Itchy ears*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Earaches, ear infections*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Drainage from ears*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Ringing in ears, hearing loss*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Nose
Stuffy Nose*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Sinus problems*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Hay fever*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Sneezing attacks*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Excessive mucus formation*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Mouth/Throat
Chronic coughing*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Gagging, frequent need to clear throat*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Sore throat, hoarseness, loss of voice*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Swollen or discolored tongue, gums, lips*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Canker sores*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

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Skin
Acne*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Hives, rashes, dry skin*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Hair loss*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Flushing, hot flashes*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Excessive sweating*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Heart
Irregular or skipped heartbeat*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Rapid or pounding heartbeat*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Chest pain*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

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Lungs
Chest congestion*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Asthma, bronchitis*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Shortness of breath*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Difficulty in breathing*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Digestive Tract
Nausea, vomiting*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Diarrhea*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Constipation*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Bloated feeling*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Belching, passing gas*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Heartburn*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Intestinal/ stomach pain*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Joints/Muscle
Pain or aches in joints*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Arthritis*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Stiffness or limitation of movement*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Pain or aches in muscles*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Feeling of weakness or tiredness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Weight
Binge eating/ drinking*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Craving certain foods*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Excessive weight*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Compulsive eating*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Water retention*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Underweight*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Energy/Activity
Fatigue, sluggishness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Apathy, lethargy*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Hyperactivity*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Restlessness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Mind
Poor memory*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Confusion, poor comprehension*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Poor concentration*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Poor physical coordination*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Difficulty in making decisions*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Stuttering or stammering*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Slurred speech*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Learning Disabilities*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Emotions
Mood swings*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Anxiety, fear, nervousness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Anger, irritability, aggressiveness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Depression*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

Other
Frequent illness*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Frequent or urgent urination*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe
Genital itch or discharge*
- Never or almost never have the symptom
- Occasionally have it, effect is not severe
- Occasionally have it, effect is severe
- Frequently have it, effect is not severe
- Frequently have it, effect is severe

Save and Continue Later

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Disclaimer:Dr. Menka Gupta* holds an MBBS degree and is not registered under the Medical Registration Act 1997 with the Singapore Medical Council. The services offered are not medical or dental services under the Healthcare Services Act 2020 and do not constitute the practice of medicine. The information provided is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Please consult a qualified healthcare provider for any medical concerns. advice, diagnosis, or treatment. The information provided on this website is not intended as a substitute for medical advice

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