LOPAI

1. Enter your basic information

Name

Gender

Date of birth: Y

M

D

Height: 100cm or more,250cm or less

Weight: 30kg or more, 300kg or less

Waistline (pants size): 18inches or more, 100inches or less

1/8

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2. Select all that apply to your current state. (Up to 3)

I get colds a lot.
Feeling lethargic and depressed for no reason.
You tend to have a loose mouth or frequent canker sores.
Conjunctivitis, styes, and other eye infections are common.
I often get enteritis.
I'm prone to urinary tract infections like cystitis.
If I get a cut, it doesn't heal very well.
I often have numbness in my fingertips and toes.
I'm constipated.
I have cavities, and my gums often swell and bleed.
I have a feeling of urine retention after urination.
I have dry skin and tend to get dandruff.
My skin is prone to inflammation.
I tend to lose a lot of hair.
None of the above.

2/8

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3. Please select all applicable conditions. (Up to 4)

I take blood pressure medication.
I take diabetes medication.
I take medication for high blood pressure.
I have other medical conditions and am on long-term medication.
None of the above.

3/8

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4. Please select all applicable nutrition information.

1) I'm managing my diet.

Yes No
2) I tend to eat brown rice and multigrain rice.

Yes No
3) I often eat legumes (tofu, soy milk, soy rice).

Yes No
4) I often eat fish (sashimi, mackerel, tuna, cutlassfish, etc.).

Yes No
5) I drink milk often.

Yes No
6) Meal times are regular.

Yes No
7) Eat snacks at least twice a day.

Yes No
8) Eat a midnight snack at least twice a week.

Yes No
9) Eat instant food at least 3 times a week.

Yes No
10) Eat fried foods, snacks, etc. at least 3 times per week.

Yes No
11) Eat animal fats (pork belly, steak, chicken, butter, etc.) at least twice a week.

Yes No
12) Drink colas and sodas at least 3 times a week.

Yes No
13) Eat sugary foods (fruit juice, chocolate, syrups, etc.) at least twice a day.

Yes No
14) Consume high-caffeine beverages (coffee, energy drinks, etc.) 3 or more times per day.

Yes No
15) I'm taking a nutritional supplement.

Yes No

4/8

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5. Please select all of the lifestyles that apply to you.

1) How much do you drink on average per week?

Rarely drink

Half a bottle or less of soju

1 bottle of soju or less

2 bottles of soju or less

At least 2 bottles of soju
2) Do you smoke?

No Smoke

Smoked in the past, but not currently

Half a packet a day or less

One pack or less per day

More than one pack per day
3) How many days a week do you exercise?

At least 4 times per week

Workout 3 times a week

Workout twice a week

1 workout a week

Rarely
4) How many steps do you take on average each day?

15,000+ views per day

10,000 - 15,000 steps per day

6,000-10,000 steps per day

Less than 6,000 steps per day
5) How many hours a day do you spend outdoors in the sun?

Less than 30 min

30 minutes to 1 hour

1 to 2 hours

2 hours or more

5/8

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6. Check all that apply for your family history.

Liver disease
Vascular disease(Heart attack, brain hemorrhage, etc.)
Bone/Joint Diseases(Osteoporosis, osteopenia, etc.)
No family history

6/8

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7. Please select all of the health areas that you are currently uncomfortable with, worried about, or interested in. (Up to 3)

Blood vessels/circulation
Digestion/Intestines
Skin
Eyes
Brain activity
Fatigue recovery
Bones and joints
Immunity
Hair (hair loss)
Liver Health
Manage weight
Stress
Insomnia
Prostate

7/8

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8. What is your usual nutritional intake?

Get all the ingredients you need
Eat only the essentials
Take only multivitamins
Eat red ginseng and antler products
Not eating

8/8

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