Dtc Camp

Average Sleep (hours/night)

Sleep Quality (1-5 scale)

Snoring / Sleep Apnea Symptoms

Perceived Stress Level (1-5)

Work Shift Pattern

Daily Working Hours (average)

Years in Current Job/Driving

Physical Activity Level

Late Dinner (After 9 PM)

Sugary Drinks per Day

Outside Food Frequency

Meal Timing Regularity

Tobacco Use

Alcohol Consumption

Digital Consent (Version 2.0): I hereby consent to the collection, processing, and secure storage of my health data for preventive screening, wellness program purposes, and anonymized research to improve public health programs. I understand that:

This data will be kept confidential and encrypted
I may receive health guidance via WhatsApp/SMS
This is NOT a medical diagnosis - I will consult a physician for medical concerns
My data will be anonymized for research purposes (identity separated from health intelligence)
I can request data deletion by contacting Diabetes Care Home

Timestamp: | Data Protection Compliant | Consent Version: 2.0

📍 Screening Information

👤 Participant Information

📋 Vital Health Parameters

🔍 Root Cause & Lifestyle Intelligence (YOUR GLOBAL EDGE)

🩺 Basic Medical History

🫀 Organ Protection Assessment - Current Symptoms

❤️ Heart Symptoms

🧠 Brain/Stroke Symptoms

🩺 Kidney Symptoms

🦶 Nerve/Circulation Symptoms

👁️ Eye/Vision Symptoms

⚕️ General Metabolic Symptoms