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Can Hastanesi

Personalized Check-Up Form

Check-Up1 min read

This short questionnaire about your lifestyle, medical history and symptoms helps our physicians plan a check-up program tailored to you.

1Personal information

2Lifestyle

Do you smoke?Do you smoke?
Do you drink alcohol?Do you drink alcohol?
Do you consider yourself physically active?Do you consider yourself physically active?
Do you walk and climb stairs?Do you walk and climb stairs?
Do you exercise regularly?Do you exercise regularly?

3Medical history and family history

Has anyone in your family or among your close relatives had cancer?Has anyone in your family or among your close relatives had cancer?
Has anyone in your family had a heart attack before the age of 50?Has anyone in your family had a heart attack before the age of 50?

4Symptoms

Do you have joint stiffness in the morning?Do you have joint stiffness in the morning?
Do you have joint or bone pain during the day?Do you have joint or bone pain during the day?
Do you feel low on energy when you wake up in the morning?Do you feel low on energy when you wake up in the morning?
Do you have hand tremors, mood swings or irritability?Do you have hand tremors, mood swings or irritability?
Have you noticed an increase in how often you urinate?Have you noticed an increase in how often you urinate?
Do you think you drink enough water?Do you think you drink enough water?
Do you feel a burning sensation when urinating?Do you feel a burning sensation when urinating?
Do you experience pain during sexual intercourse?Do you experience pain during sexual intercourse?
Do you have trouble seeing distant or nearby objects?Do you have trouble seeing distant or nearby objects?
Do you experience double vision?Do you experience double vision?
Do you have difficulty driving at night?Do you have difficulty driving at night?
Do you have head or neck pain?Do you have head or neck pain?
Do you have a sore throat?Do you have a sore throat?
Do you feel food getting stuck in your throat when swallowing?Do you feel food getting stuck in your throat when swallowing?
Do you ever forget the names of familiar objects?Do you ever forget the names of familiar objects?
Do you forget the names of friends or acquaintances?Do you forget the names of friends or acquaintances?
Have you ever been unable to find your way home?Have you ever been unable to find your way home?
Do you have hair loss?Do you have hair loss?
Do you get increased itching after bathing?Do you get increased itching after bathing?
Do you sweat excessively?Do you sweat excessively?
Do you have dry skin?Do you have dry skin?
Do you suffer from nausea or vomiting?Do you suffer from nausea or vomiting?
Have you noticed blood in your stool?Have you noticed blood in your stool?
For women: are your periods regular?For women: are your periods regular?
Are your periods very painful?Are your periods very painful?
Have you had your blood pressure measured in the last month?Have you had your blood pressure measured in the last month?
Do you feel bloated after meals?Do you feel bloated after meals?
Do you feel very sleepy after meals?Do you feel very sleepy after meals?
Do you get diarrhea very often?Do you get diarrhea very often?
Do you catch the flu very often?Do you catch the flu very often?
Do you sweat a lot at night?Do you sweat a lot at night?
Have you had significant weight loss in the last 6 months?Have you had significant weight loss in the last 6 months?
Do you stop breathing during sleep?Do you stop breathing during sleep?
Do you have ringing in your ears?Do you have ringing in your ears?
Do you have balance problems when standing?Do you have balance problems when standing?
Do you see flashes of light in your eyes?Do you see flashes of light in your eyes?
Do your joints make noises when you move?Do your joints make noises when you move?
Do you have any lumps in your armpits or groin?Do you have any lumps in your armpits or groin?
Do you get a bitter or sour taste coming up into your mouth?Do you get a bitter or sour taste coming up into your mouth?
Do you have joint pain?Do you have joint pain?
Do you have lower back pain?Do you have lower back pain?
Do you have weakness or an electric-shock sensation in your arms or hands?Do you have weakness or an electric-shock sensation in your arms or hands?
Is your urine flow interrupted?Is your urine flow interrupted?
Do you feel that your bladder is not completely empty after urinating?Do you feel that your bladder is not completely empty after urinating?
Do you have chest pain when walking?Do you have chest pain when walking?
Do you have palpitations?Do you have palpitations?
Do you have a cough or bring up phlegm?Do you have a cough or bring up phlegm?
Do you have swelling in your body or legs?Do you have swelling in your body or legs?
Do your hands turn white in cold weather?Do your hands turn white in cold weather?
Are you short of breath? Can you sleep lying on a single pillow at night?Are you short of breath? Can you sleep lying on a single pillow at night?

* The Send button will be enabled once you accept the KVKK Privacy Notice and give explicit consent for your health data.

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The information on our website is not intended to direct individuals to any treatment. Do not take any diagnostic or treatment steps without consulting your doctor. The content does not contain information about İzmir Can Hastanesi's therapeutic healthcare services.

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