Q-1 Are you having any of these?
Q-2 Did you had any one of the above listed disorders ever in life time for a short while?
If Yes which one -
Q-3 Any Surgery ever?
Q-4 If you are a married female (otherwise ignore)
Q-5 Do you have history (Mother / Father / Maternal or Paternal Pools) towards any
Q-6 Do you have any allergy with any Foodstuff?
Q-7 If you weight Loss or weight Gain patient, have you tried anything before
Q-8 Do you have any activity right now like :
Q-9 What is your daily diet pattern of what you eat & how much?
Q-10 How frequently do you eat out?
Q-11 Do you smoke?
Q-12 Do you consume Alcohol, If Yes how frequently / How much?
Any Suggestions / Query