Centre for Advanced Medicine

Cardiometabolic Questionnaire

Understanding the key contributors to your cardiometabolic health will help you and your health care provider identify the best course of action to address issues and improve your overall health. After reviewing the cardiometabolic Questionnaire with your health care provider, please refer to the CM Vitals Patient Handbook for dietary, exercise, lifestyle and nutrient therapy recommendations.

Have you ever been told
that you have high
cholesterol?

Yes

No

Do you regularly consume
soft drinks or fruit
juices?

Yes

No

Do you have a family
history of high
cholesterol?

Yes

No

Do you typically snack on
chips, cookies, crackers
or granola bars?

Yes

No

Have you been diagnosed
with diabetes?

Yes

No

Do you typically snack on
chips, cookies, crackers
or granola bars?

Yes

No

Have you been diagnosed
with an autoimmune
disease?

Yes

No

Do you have frequent
sugar cravings?

Yes

No

Do you eat within three
hours of bedtime?

Yes

No

Do you feel tired often?

Yes

No

Do you regularly consume
soft drinks or fruit
juices?

Yes

No

Do you experience
anxiety?

Yes

No

Have you been diagnosed
with high blood pressure?

Yes

No

Do you regularly consume
food from restaurants or
packaged foods?

Yes

No

Do you frequently have
headaches or migraines?

Yes

No

Are you considered
overweight?

Yes

No

Do you experience
frequent bruising?

Yes

No

Do you suffer from
hemorrhoids?

Yes

No

Do you experience muscle
cramps?

Yes

No

Do you have delayed wound
healing?

Yes

No

Do you suffer from
varicose veins?

Yes

No

Disclaimer: This tool does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read here or anywhere online. If you think you may have a medical emergency, immediately call your doctor or dial 911.