Dickson Health Risk Assessment

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The following questions will help determine if you are at risk for health issues. Inflammation is the underlying cause of all disease and these symptoms may indicate inflammation in your body. The answers will help you identify potential threats to your health and areas you may need to work on to prevent chronic pain and disease. Please be as honest as possible with your answers and tell us what we “need” to hear and not necessarily what we “want” to hear.

Email *

Name *

How do you measure up?.......Know your risk!

Do you have a family history of early cardiovascular disease (heart attack, bypass, transplant or stroke (a male relative affected before age 55+ or a female relative affected before age 65)? *

5 points

No, but I do have a family member with later onset heart disease

Yes, on one side of the family

Yes on both sides of the family

Yes, and it is present in multiple generations

Do you have bleeding gums or gum disease? (Check all answers that apply) *

5 points

Never

I usually don’t floss but my gums never bleed or hurt

I usually don’t floss my teeth but my gums are sensitive:

Yes, when I brush or floss

My gums bleed without even having to floss my teeth

Which of the following best describes your sleep patterns? *

5 points

I sleep soundly 7-8 hours a night

I sleep but restlessly for 6-8 hours a night

I sleep less than 7 hours or more than 9

I sleep less than 5 hours of poor quality sleep per night

I sleep less than 4 hours a night

Do you snore? *

5 points

Yes, occasionally

Yes, frequently and loudly

Yes, and I have sleep apnea

Yes and I have sleep apnea and so does at least one family member

Do you have rheumatoid arthritis, Celiac’s disease, a thyroid condition, psoriasis, lupus or any other inflammatory/autoimmune disease? *

5 points

Yes, but it is controlled by medication

Yes, even though I am taking medication I still have consistent symptoms

Yes and symptoms are consistent and debilitating with or without medication

Yes and so does at least one family member

Have you been checked for vitamin D deficiency? *

5 points

My vitamin D level is between 60-80

My vitamin D level is between 40-60

My vitamin D level is between 30-40

My vitamin D level is lower than 30

I do not know my vitamin D level

Do you have a history of migraine headaches? *

5 points

Occasionally, but with no migraine aura

Yes on a regular basis, with no migraine aura

Yes on a regular basis, with a migraine aura

My headaches are debilitating, are all consuming and I have lost the ability to function

How would you characterize your ability to cope with stress? *

5 points

I’m usually pretty laid back

I have stress but I have healthy ways to cope with stress

Sometimes people say that I seem stressed

I feel stressed and anxious most of the time

I feel stress all of the time and it is interfering with my life and my relationships

How much TOTAL time do you spend sitting (job, driving, home, TV, computer etc.)? *

5 points

Less than 5 hours

Less than 7 hours

More than 9 hours

More than11 hours

More than 13 hours

How much formal exercise (cardio, mobility and strength training) do you get? *

5 points

At least 30 minutes, 5 to 7 days per week

At least 30 minutes 2 to 4 times per week

At least 30 minutes 1 to 2 times per week

30 minutes, once a week or less

I do not exercise

Do you smoke or use tobacco products? *

5 points

I used to smoke, but have quit for at least 5 years

I used to smoke, but quit less than 5 years ago

I am exposed to second hand smoke regularly

I smoke/use smokeless tobacco products infrequently (1-3 times per day)

Do you drink regular or diet soft drinks? *

5 points

Never

Rarely drink soda (diet or regular)

Once a week (diet or regular)

2-3 per week

Once or more a day

(Women only): Did you experience high blood pressure or gestational diabetes during pregnancy?

5 points

Yes

Clear selection

(Men only): Do have erectile dysfunction?

0 points

Yes

Clear selection

Do you take supplements daily that were recommended or prescribed by your health care provider? *

5 points

Yes, every day

Yes, but only 5 days per week

Yes, when I remember

Not that were recommended by a health care provider but I do take supplements

No, I don’t take any supplements

Do you have diabetes or high blood sugar? *

5 points

No but I have a family member that does

Yes, I’m pre-diabetic and or insulin resistant

Yes, I’m diabetic

I haven’t had my blood sugar tested

Do you have pain of any kind? *

5 points

Yes, 1-2 times per month

Yes, 1-2 times per week

Yes, more than 1-2 times per week

Yes, every day and constant

Do you have healthy relationships and a rich social network of friends and activities? *

5 points

Absolutely, totally agree

Somewhat agree

I wouldn’t call it “rich” but I have friends and see them from time to time

I really don’t have a lot of friends and see them occasionally

I don’t have any friends and I really like it that way

Do you drink alcohol? *

5 points

Yes, 1-2 glasses 3x or less per week (3-6 glasses total)

Yes, 1-2 glasses 7x per week (7-13 glasses total)

Yes, more than 2 glasses 7x per week (14+ glasses total)

Yes, every day and more than 3 drinks in a day

Do you eat meals or snacks that contain sugar in any form like cookies, cakes, candy, pastas, sugar-laden sauces such as ketchup, breads, etc.? *

5 points

No, never

Yes, monthly 1-4 meals or snacks contain sugar

Yes, weekly 2-3 meals or snacks contain sugar

Yes, daily 2-3 meals or snacks contain sugar

Yes, daily 4+ meals or snacks contain sugar

Are you taking medication for chronic medical problems such as digestivedisorders; cardiovascular problems; high cholesterol; headaches; chronic pain; blood sugar problems; chronic fatigue; immune problems or chronic infections; or any other chronic conditions? *

5 points

1 medication

2 medications

3 medications

4 + medications

Submit to find out your health risk!

100-90

You have great health. Continue of your healthy lifestyle to
help you maintain your health.

89-80

You have some health risks, knowing your lab and
Wellness score will help direct you to improve your health and prevent
future chronic disease.

79 – 70

You have moderate risk for serious health problems, knowing your
Lab and wellness score will help you improve your health and you
need to make some serious lifestyle changes to regain your health.

69 – 60

You have a moderately high risk for cardiovascular disease, you need to
know the red flags for heart attack and stroke as well know your lab
and wellness score to make an immediate action plan to change your
lifestyle and protect your health

Below 59

You have a high risk for cardiovascular disease, and other chronic inflammatory
Conditions. Do not delay in having your labs and wellness score done. These two
tests could save your life.

Submit

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