Health Perception, Values

Do you have any medical history, such as surgery or a chronic illness?

Do you smoke, drink, or use drugs?

Are there any religious rules or practices?

2. Nutrition Do you eat nutritious meals?

Do you prefer to make your own meals or eat out?

Did you have any difficulties obtaining healthy nutrition?

3. Relax and sleep

1. How long do you usually sleep?

2. What time do you go to bed and what time do you get up?

3. Do you suffer from sleep apnea?

4. Exclusion

How frequently do you have bowel movements?

Do you have any diarrhea or constipation?

Do you have any bladder incontinence?

5. Physical Activity/Exercise

Do you work out on a regular basis?

What kind of exercises do you prefer?

Do you exercise regularly?

What kind of exercises do you prefer?

Do you exercise in a health club or at home?

6. Cognitive

Do you have any problem with memory or concentration?

Do you have difficulty making decisions?

Do you participate in cognitive activities, and how often?

7. Sensory-Perception

Do you have any disabilities in sensory?

Do you have a common sensory disability in the family?

Have you been treated for any sensory problems?

8. Self-Perception

Do you feel anxious or depressed?

Do you feel loss of hope?

Would you describe yourself as an optimist or pessimist?

9. Role Relationship

Are you married or single?

Who provides for the family?

What are the major concerns for you as a part of the family

10. Sexuality

Do you have satisfactory sexual functioning?

Do you perform regular check-up for your reproductive health

Do you discuss sexuality with children?

11. Coping

How do you handle stress?

Are you taking any medication, drugs or alcohol to relax?

What strategies do you use to solve any serious problems?