Home The Body Find a Practitioner Condition Center Nutrition Center Exercise Center Resource Center About Us
Health Shop My HealthRecord Chiropractic Book Store Free Tests Products & Services Health News Search Contact Us
 
My Psychological/Social History
ERROR
{TOPMESSAGE}
My Psychological/Social History
Our emotions and social activities broadly affect our health. The inability to change our environment and make it adapt to our needs is one of the biggest challenges we have in life. Unhappy interpersonal relationships can not only ruin one's life, it can also make you sick. We all have difficulties in life or life wouldn't be a game. The happy, successful person tackles their environment, while the depressed and unsuccessful person doesn't. We are here to help you straighten out any life difficulties you may be having.

The information you enter in this form is completely confidential and is not shared with any other source, unless requested in writing.

My Psychological/Social History (Required)
Factors Affecting Emotions & Health
These questions focus on lifestyle factors that can affect emotions.
1) How many hours of sleep do you get on average over a 7 day period?
 
2) How many hours of sleep do you require to feel refreshed when you wake up?
 
3) Does your work, family situation, or other factors affect your ability to get a good night's sleep? If yes explain:
No Yes
 
 
4) Are you having difficulties with any interpersonal relationship in your life? This could be family, friends or a work situation. If yes, please give the details including the length of time this has been a problem and the difficulties you are having:
No Yes
 
 
5) Are you reaching the goals you have set in life? If not, what obstacles or difficulties are preventing you from doing so?
No Yes
 
 
6) Do you feel sad or depressed even though there's not a logical reason for feeling so?
No Yes
 
 
7) Do you have "spacey" or unreal feelings? If yes, describe:
No Yes
 
 
8) If you were to rate your overall energy level from 0 to 10, with 0 being totally fatigued and bed-ridded to 10 being endless energy, what would you rate your average energy level? Add any additional information
 
 
9) Have you had a severe shocking loss such as the loss of a loved one, or a similar type of trauma, that continues to haunt you?

if yes, describe what happened and how it is affecting you:
No Yes
 
 
10) Do you take any of the following psychoactive drugs?
(more than one choice is possible)
No
Improvements I Want in Life
11) If there were unwanted situations you could get rid of in your life, what would they be?
I am well adjusted in life and there are not unwanted situations

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.
 
 
 
12) What help do you need in getting rid of the situations you listed above? (Answer if you listed any situations above).
 
 
13) Add any additional comments that
you feel may be important in
your situation
 


This personal information will be saved into your MyHealth Record Profile. It will also be used by your on-line doctor to make personalized recommendations. Your history is also used to setup your free My Journal to make tracking your progress even easier.



The inability to sleep places severe stress on the body and can result in digestive problems, fatigue and a host of other unwanted conditions.










Difficulties with family, friends, and co-workers can create huge undue stress which can lead to fatigue, degenerative conditions and overall poor health.






Past emotional trauma such as the loss of a loved one or the threat of loss can affect a person for their entire life and can trigger unwanted feelings as well as phycical problems. This is known as psycho-somatic disease, psycho, meaning "spirit" and somatic meaning "of or pertaining to the body.".




































Improving conditions in life requires a knowledge of life itself. Once your difficulties are known, something can be done.
Please review this form to be sure you have answered the appropriate items and that your answers are accurate. Thank you for choosing BecomeHealthyNow.com. We look forward to helping you achieve your your health goals.
 
Please Note:
You have already completed this sub-section of the MyHealth Analysis questionnaire. Your answers are recorded above for you to review. If any of the data in the form is NOT correct and you need to CHANGE your answers, click the appropriate button below. You will then be allowed to make any necessary changes.
Please Note This Section is Complete:
You have already completed this entire section of the MyHealth Analysis questionnaire. Your answers are recorded above for you to review. If any of the data in this subsection or any other subsection is NOT correct and you need to CHANGE your answers, call your on-line doctor, {doc_name} at {doc_phone}. He will make this entire section incomplete and you will be able to make changes to any sub-section. Your previous answers will NOT be lost, and you will be able to review each sub-section and make changes.

up Top  Home Home
Search Contact Us About Us
The Human Body Find a Practitioner Condition Center Nutrition Center Exercise Center Resource Center Forums
Health Shop My HealthRecord Chiropractic Book Store Free Tests Products & Services Health News

Information on this site is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. You should read carefully all product packaging. If you have or suspect that you have a medical problem, promptly contact your health care provider. Copyright © 2000-2008, BecomeHealthyNow.com, Inc. All rights reserved. View our privacy statement here. While we carry Standard Process products, neither BecomeHealthyNow.com nor any third party associated with, related to or linked to BecomeHealthyNow.com's business or website is in any way affiliated with Standard Process. Standard Process has asked us to make clear that it expressly disclaims any responsibility for and makes no representations or warranties regarding any statement, information, materials or content found on our website or any third party marketing materials or websites related to, associated with or linked to BecomeHealthyNow.com's business or website.
 
For more information, e-mail us BecomeHealthyNow.com, Inc519 Cleveland St Ste 115Clearwater, FL 33755
Terms of Use Privacy Policy