1. Health Evaluation
How do you think your health is, all in all?
2a. Have you used painkillers, headache pills in the last 3 months?
2b. Have you used sedatives or nerve medicine in the last 3 months?
2c. Have you used sleeping pills in the last 3 months?
Do you have - or have you had - problems with heavy alcohol consumption?
Do you have - or have you had - problems with other drugs?
If smoker, how much per day?
5. How often do you usually eat fruit, salad / raw food, cooked vegetables (apart from potatoes)?
6. Physical activity and exercise
6. Which description suits you best?
7. Mental health
7a. In the last 4 weeks, how often have you slept badly and restlessly?
7b. Within the last 4 weeks, how often have you felt run down?
7c. Within the last 4 weeks, how often have you been tense?
8. Physical pain problems
8a. Have you had neck problems in the last 7 days?
8b. Have you had shoulder problems within the last 7 days?
8c. Have you had problems with your arms / elbows within the last 7 days?
8d. Have you had problems with your hand / wrist within the last 7 days?
8e. Have you had low back pain in the last 7 days?
8f. Have you had knee problems in the last 7 days?
9. Have you had one or more of the following diseases?
9a. Heart pain (angina pectoris)
9d. Gastric ulcer / Severe intestinal disease
9e. Depression, requiring treatment
9g. Lung disease (eg Asthma or Allergy)
Is there anything else you want to inform us about before the survey? (Eg any omissions in the content of the survey)
Comments on the Questionnaire
AG Sundhedsfremme ApS uses your answers, combined with the measured health data in the upcoming survey, to advise you about your health. The answer will, in anonymised form, also be included in a comprehensive report to the company, however in such a way that no individuals can be identified. When you give your consent for the above purpose, you also give AG Sundhedsfremme's nurses and statisticians the right to process your information in this questionnaire. You can always withdraw your consent by writing to ANTR@AGSundhed.dk
If you are human, leave this field blank.