Health Intake Form

请选择与您相关的症状(可多选)Please select the symptoms that match your condition (Multiple choice)
症状 / Symptoms
A. 慢性疾病 Chronic Diseases Chronic Diseases • 高血圧 Hypertension • 高脂肪 Hyperlipidaemia • 高胆固醇 Cholesterol • 高血糖 Hyperglycaemia • 高尿酸 Uric Acid • 脂肪肝 Fatty Liver • 酒精肝 Alcoholic Liver • 甲状腺机能亢进/甲状腺机能低下 Thyroid (Hyperthyroidism / Hypothyroidism)	B. 心脑血管 Cardiovascular & Cerebrovascular Cardiovascular & Cerebrovascular • 头痛 Headache • 偏头痛 Migraine • 冠心病 Coronary Heart Disease • 心脏病 Heart Disease • 心血管 Cardiovascular Issues • 心肌缺血 Myocardial Ischemia • 血栓 Thrombosis (Blood Clot) • 脑梗/中风 Stroke • 手脚麻痹 Numbness	C. 肠胃问题 Digestive Issues Digestive Issues • 消化不良 Indigestion • 肠胃吸收差 Poor Absorption • 胃胀气 Stomach Bloating • 便秘 Constipation • 胃酸倒流 Gastroesophageal Reflux
D. 呼吸系统 Respiratory System Respiratory System • 哮喘 Asthma • 气喘 Shortness Of Breath • 肺气不足 Weak Lung Function • 过敏性鼻炎 Allergic Rhinitis • 气管炎 Bronchitis • 肺气肿 Emphysema	E. 皮肤炎症 Skin Inflammation Skin Inflammation • 湿疹 Eczema • 手足癣 Athlete’s Foot / Hand Tinea • 牛皮癣 Psoriasis • 灰指甲 Fungal Nail • 皮肤过敏 Skin Allergy • 皮肤暗哑无光 Lack of Radiance • 色斑/雀斑/黑眼圈 Pigmentation / Freckles / Eyes Dark Circles • 肤色暗沉 Dull Skin Tone • 敏感泛红 Sensitive Redness	F. 关节、神经系统 Joint & Nervous System Joint & Nervous System • 关节炎 Arthritis • 骨刺 Bone Spurs • 坐骨神经 Sciatica
G. 睡眠障碍 Sleep Disorders Sleep Disorders • 失眠 Insomnia • 浅眠 Light Sleep • 多梦 Excessive Dreaming	H. 妇科炎症 Gynaecological Inflammation Gynaecological Inflammation • 乳腺增生 Mastopathy • 内分泌紊乱 Hormonal Imbalance • 子宫肌瘤 Fibroids • 白带 Abnormal Discharge • 痛经 Menstrual Pain • 更年期 Menopause	I. 男性炎症 Male Inflammation Male Inflammation • 前列腺炎 Prostatitis • 前列腺增生 Prostatic Hyperplasia

个人健康登记表

Wellness Assessment Form

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