Phase two of eight

25%

Medical Questionnaire 2 – Oxidative Stress

Illness / Disease

Do you often suffer from respiratory diseases? *

Yes

No

Do you suffer from rheumatism? *

Yes

No

Do you suffer from joint pain? *

Yes

No

Do you suffer from chronic bowel inflammation? *

Yes

No

Do you suffer from blood circulation disorders? *

Yes

No

Do you suffer from bronchial asthma? *

Yes

No

Do you have a heart disease such as agina, pectoris heart attack or heart rhythm problems? *

Yes

No

Are you a diabetic? *

Yes

No

Do you take medication? *

Yes

No

Lifestyle

Do you exercise regularly? *

Yes

No

Are you exposed to second-hand cigarette smoke? *

Yes

No

Do you drink more than three alcoholic drinks per day? *

Yes

No

Environment

Do you live in a big city (more then 250,000 inhabitants)? *

Yes

No

Are you suffering from stress? *

Yes

No

Do you have any old dental fillings (amalgam)? *

Yes

No

Does your work environment expose you to gas fumes, saw dust, asbestos, radiation, or other harmful substances? *

Yes

No

Do you go out drinking and partying more than three times per week? *

Yes

No

In the last few weeks, have you spent a lot of time in the sun (sports, vacation)? *

Yes

No

Would you consider yourself a couch potato? *

Yes

No