Free Health Checkup By TII Pvt Ltd & MantraCare

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Feeling nervous, anxious or on edge?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Not being able to stop or control worrying?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Trouble relaxing?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Being so restless that it is hard to sit still?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Becoming easily annoyed or irritable?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling afraid as if something awful might happen?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Little interest or pleasure in doing things?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling down, depressed, or hopeless?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Trouble falling or staying asleep, or sleeping too much?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling tired or having little energy?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Poor appetite or overeating?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling bad about yourself – or that you are a failure or have let yourself or your family down?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Trouble concentrating on things, such as reading the newspaper or watching television?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Moving or speaking so slowly that other people could have noticed?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Thoughts that you would be better off dead, or of hurting yourself in some way?

Not At All

Several Days

More Than Half the days

Nearly Everyday

Feeling Stressed, burdened or hassled?

Not At All

Several Days

More Than Half the days

Nearly Everyday

What are the key reasons for your stress/ anxiety?

Relationships

Family

Health

Financial

Work

Job Security

Physical Wellbeing

Gender

Male

Female

Your Age

Weight (Kgs)

Height (ft)

Height (in)

How long do you exercise in a day?

Do you have any known health conditions?

None

Diabetes

PCOS

Hypertension

Physical Pain(Back/ Neck / Knee)

Thyroid

Cholesterol

Heart Disease

Any family member suffering from these conditions?

None

Diabetes

PCOS

Hypertension

Physical Pain(Back/ Neck / Knee)

Thyroid

Cholesterol

Heart Disease

Do you experience any of these things?

None

Pee a lot

Always Thirsty

Always Hungry

Feel very tired

Sudden Loss of weight

Blurry vision

How often do you smoke in a day?

Don’t smoke at all

Less than 5

Between 5 to 10

More than 10

How many drinks do you have in a week?

Don’t drink at all

Less than 5

Between 5 to 10

More than 10

How many hours do you Sleep daily?

Less than 4 hours

4 to 6 hours

6 to 8 hours

More than 8 hours

How often do you face difficulty sleeping?

Not at all

Several Days

Nearly Everyday

Do you feel the need for a Wellbeing program (Therapy, Yoga, Physio, Dietician) for employees?

Yes

All done! Enter the following details to get the result (your details will be kept confidential)

Name

Email Id

Company Name

Hidden

Company Name Hidden

Phone

Hidden

Your Anxiety Score

Hidden

Low Anxiety Text

Hidden

Mild Anxiety Text

Hidden

Moderate Anxiety Text

Hidden

Severe Anxiety Text

Hidden

Your Depression Score

Hidden

Low Depression Text

Hidden

Mild Depression Text

Hidden

Moderate Depression Text

Hidden

Severe Depression Text

Hidden

Your Stress Score

Hidden

Low Stress Text

Hidden

Mild StressText

Hidden

Moderate Stress Text

Hidden

Severe Stress Text

Hidden

Overall Mental Health

Hidden

Low Overall Text

Hidden

Mild Overall Text

Hidden

Moderate Overall Text

Hidden

Severe Overall Text

Hidden

BMI

Hidden

Underweight BMI Text

Hidden

Overweight BMI Text

Hidden

Normal BMI Text

Hidden

BMR

Hidden

Diabetes

Hidden

Low Diabetes Text

Hidden

Mild Diabetes Text

Hidden

High Diabetes Text

Hidden

Sleep

Hidden

Medium Sleep Text

Hidden

High Sleep Text

Hidden

hypertension

Hidden

Low Hypertension Risk Text

Hidden

High Hypertension Risk Text

Hidden

physical

Health Assessment

Over the last 2 weeks, how often have you been bothered by any of the following problems?

Physical Wellbeing

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