Please provide your personal details-

History of illness-

Diabetes

Hypertension

Heart Problems

Kidney Problems

Body and Mind(B&M) Assessment-

Please complete the questionnaire carefully. It will take only 5 minutes. Focus on the past 30 days, read each question thoroughly, and select the most accurate option for yourself.

Feeling nervous or like something bad might happen

Worrying too much about many things

Unable to relax

Feeling restless and unable to sit still

Getting annoyed or angry very easily

Feeling your heart beating very fast

Feeling afraid for no clear reason

Losing interest in enjoying things you used to like

Trouble sleeping or sleeping too much

Feeling tired all the time

Not feeling hungry, or eating less than usual

Finding it hard to focus or think clearly

Moving or talking very slowly, or very fast

Having frequent Gas, Acidity, or stomachache

Feeling back pain often

Pain in your arms, legs, or joints

Getting headaches often

Feeling pain in your chest

Feeling dizzy or lightheaded

Feeling like you might faint

Feeling your heart beating very fast or hard

Having trouble breathing or feeling short of breath

Do you feel like weeping or do cry sometimes