Cardiometabolic Clinic New Patient Questionnaire

  • Do you consider yourself healthy?

  • Do you consistently get 7-9 hours of sleep per night?

  • Do you feel rested when you wake up?

  • Do you feel your energy level is adequate?

  • Do we understand the mechanism of action?

  • Do you wish you had more energy?

  • Does your energy dip frequently throughout the day?

  • Are you overweight or obese? If so, do you feel this is affecting your health?

  • Do you have body aches/joint pain?

  • Do you have GI complaints (gas, bloating, pain, diarrhea, constipation)?

  • Do you feel your diet is healthy?

  • How often do you eat at restaurants, eat fast foods, foods that come in a box/wrapper, have >5 ingredients, have added sugar?

  • Do you exercise? If so, what sorts of exercise do you do?

  • Are you physically active? If so, how?

  • Are you happy with your physique?

  • Do you feel physically strong?

  • How would you describe your stress level? (Low, medium, high)

  • What do you do in your down time?

  • What are your goals while woking with the CTC Cardiometabolic Clinic?