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Follow-Up Check-In

1. Personal & Body Composition

Basic details we need before your consult.

Full Name *

Email Address *

Digestive Health — Do you experience bloating or gas after meals? *NeverRarelySometimesOftenAlways

Digestive Health — Do you have irregular bowel movements? *NeverRarelySometimesOftenAlways

Digestive Health — Do you experience acidity or reflux? *NeverRarelySometimesOftenAlways

Detoxification — Do you feel sluggish or fatigued regularly? *NeverRarelySometimesOftenAlways

Detoxification — Do you have skin issues such as eczema or breakouts? *NeverRarelySometimesOftenAlways

Immune / Defence — Do you catch colds or infections frequently? *NeverRarelySometimesOftenAlways

Immune / Defence — Do you have seasonal allergies? *NeverRarelySometimesOftenAlways

Inflammation & Hormonal Balance — Do you experience joint or muscle pain? *NeverRarelySometimesOftenAlways

Inflammation & Hormonal Balance — Do you have irregular menstrual cycles (if applicable)? *NeverRarelySometimesOftenAlways

Inflammation & Hormonal Balance — Do you experience mood swings or hormonal symptoms? *NeverRarelySometimesOftenAlways

Cellular Transport — Do you experience numbness or tingling in extremities? *NeverRarelySometimesOftenAlways

Cellular Transport — Do you have poor circulation symptoms? *NeverRarelySometimesOftenAlways

Energy Levels — Do you feel tired even after a full night's sleep? *NeverRarelySometimesOftenAlways

Energy Levels — Do you experience brain fog or difficulty concentrating? *NeverRarelySometimesOftenAlways

Structural Health — Do you experience back or joint stiffness? *NeverRarelySometimesOftenAlways

Structural Health — Do you have recurring headaches? *NeverRarelySometimesOftenAlways

4. Consent

Please review and confirm before submitting.

DPDP Consent *

I consent to Hopewell Healthcare collecting and processing my personal and health information for this wellness assessment, in accordance with India’s Digital Personal Data Protection (DPDP) Act. [PLACEHOLDER – final consent wording pending legal review] I agree to the privacy policy and terms and conditions.

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