This is a comprehensive form; designed to address your health on many levels; physical, energetic, mental, and emotional. Do your best to complete the form/quiz; please know that strict confidentiality is maintained and your answers are not shared with others.
Don't think too much and go by your first instinct.

Welcome to your 5 Element Diagnosis

Email
1) Which part of the body you feel any problem; not according to the doctor but according to your experience:
2) According to your experience which of the following category your problem lies in:
3) In which of the following category you have issues:
4) Which of the following areas you face the problem:
5) Given an option what would you love to eat first:

To answer questions 6 to 10, give yourself a score out of 10 by filling the small text boxes. (10 is max. & 1 is min.)

6) How much lie can you speak if it solves your purpose?
7) How many ambitions of yours got fulfilled in your life?
8) How much emotional are you with your close ones?
9) How fast you take a decision about an important work?
10) How introvert are you?
11) In which of the following category your problem lies:

Fill the following details about yourself:

12) Gender
13) Full Name
14) Age
15) Height (in Inches):
16) Weight (in kg):
17) Date of Birth (mm/dd/yyyy):
18) Do you come under one of the following category:
19) Describe your medical diagnosis if any: