LifeStyle

Section 1 of 6

Medical & Lifestyle Risk Factors

Understanding your current physical baseline.

Have you been diagnosed with or are showing symptoms of any of the following?

Check all that apply.

Diabetes or pre-diabetes Hypertension or heart disease Thyroid or hormonal imbalance Arthritis, obesity, or chronic fatigue Anxiety, depression, or insomnia None of the above

Do you smoke or use tobacco? *

Never Occasionally Former smoker Regularly

Do you consume alcohol? *

No Occasionally Regularly

If you consume alcohol, how many drinks per week? *

None 1–3 drinks 4–7 drinks More than 7 drinks

How often do you exercise or engage in physical activity? *

Daily 3–5 days/week 1–2 days/week Rarely or never

Section 2 of 6

Nutrition & Detox

Each question measures a validated dietary or biochemical risk marker for chronic disease.

What best describes your regular diet pattern? *

Vegan — whole plant-based, low salt, rich in fruits, vegetables, legumes, nuts, and seeds; minimal oil, no dairy or animal foods Vegetarian with dairy Vegetarian with dairy and occasional animal foods (fish or eggs) Mixed diet with regular animal products (meat, eggs, dairy) and moderate plant intake Predominantly animal-based or high in refined carbs, fried, or packaged foods High in processed, fast, or sugary foods (frequent dining out, low fresh produce)

Do you ensure adequate nutrient sufficiency for Omega-3, Vitamin B12, and Vitamin D3? *

Consistently (include flax/chia daily, sunshine exposure, B12 supplementation) Often, but not regularly Occasionally Rarely or never

How hydrated are you throughout the day? *

Consistently hydrated; drink 2–3 L water daily Somewhat hydrated; drink when thirsty Often forget to drink water Frequently dehydrated (dark urine, dry mouth)

Do you practice any fasting or detoxification routine (e.g., 16:8, Ekadashi, or Navratri fasts)? *

Yes, regularly (weekly or biweekly) Occasionally (monthly) Rarely Never

How much of your diet includes fruits and vegetables (especially greens and berries)? (1 serving ≈ 1 cup raw or ½ cup cooked) *

8+ servings/day (includes berries and leafy greens daily) 5–7 servings/day 2–4 servings/day Fewer than 2 servings/day

How often do you consume oils, sugar, or refined carbs? *

Rarely or never Occasionally (small amounts in home-cooked food) Regularly (used in most meals) Daily, with frequent sugary or fried foods

How frequently do you consume herbs and spices such as turmeric, ginger, garlic, or tulsi? *

Daily Often (a few times/week) Rarely Almost never

Section 3 of 6

Circadian Rhythm & Sleep

Syncing body repair cycles with nature's clock.

How many hours of sleep do you get daily? *

7–9 hours (optimal) 6–7 hours 5–6 hours Less than 5 hours Irregular — no consistent schedule

Do you sleep and wake aligned with natural sunrise/sunset rhythms? *

Always Mostly Occasionally Rarely Never

Do you use screens within 1 hour before sleep or immediately after waking? *

Never Occasionally Sometimes Frequently Always

Section 4 of 6

Physical Activity & Body Use

Movement and lymphatic activation.

Do you walk or move 10,000+ steps daily? *

Daily 3–5 days/week Occasionally Rarely Never

Do you sit continuously for more than 1 hour without movement? *

Never — I take regular movement breaks Occasionally Sometimes Often Almost always

Do you engage in strength training, yoga, or mobility practices? *

Daily 3–4 days/week Occasionally Rarely Never

Section 5 of 6

Emotional & Spiritual Health

Hormonal harmony and inner stability.

How connected do you feel to family, friends, or community? *

Deeply connected Mostly connected Sometimes Rarely Isolated

How often do you feel anxious, restless, or emotionally drained? *

Rarely Sometimes Often Most of the time Always

Do you practice gratitude, prayer, or mindfulness regularly? *

Daily Several times/week Occasionally Rarely Never

Section 6 of 6

Digital Ecology & Nervous System Hygiene

Managing overstimulation and supporting nervous system repair.

How much time do you spend daily on non-work screens (social media, entertainment, browsing)? *

Less than 1 hour 1–3 hours 3–5 hours 5–7 hours More than 7 hours

How often do you consume negative or emotionally triggering online content (news, social media conflicts)? *

Rarely Occasionally Sometimes Often Almost always

Do you feel mentally tired, anxious, or inadequate after scrolling online? *

Never Occasionally Sometimes Often Always

Do you check your phone within 30 minutes of waking or before bed? *

Rarely Sometimes Often Almost always Constantly

When was your last digital detox (a full day without screens)? *

This week This month 2–3 months ago Over 6 months ago Never

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Your Lifestyle Disease Risk

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