Cancer: Check Your Risk Quotient

Please Select All Answer (required)

Section A

1.Did you live in a joint family during your childhood?

Yes No 

2.Do you live in a joint family now?

Yes No 

3.Are you in a healthy married life?

Yes No 

4.Are you overly protected to your family?

Yes No 

5.Are you the only person taking care of financial need of your family?

Yes No 

6.Do you have Cancer history in your family?

Yes No 

7.Do you have any long standing conflict in your life – personal or professional?

Yes No 

8.Do you feel betrayed in life?

Yes No 

9.Do you always help others putting your own need aside?

Yes No 

10.Are you going through any kind of financial crisis?

Yes No 

11.Do you always fear of losing in a relationship?

Yes No 

12.Do you feel unloved by your partner or family?

Yes No 

13.Do you have difficulty in expressing your love?

Yes No 

14.Do you feel guilty of not fulfilling needs of your loved ones?

Yes No 

15.Do you have difficulty in expressing your feelings when hurted by your near and dear ones?

Yes No 

16.Do your friends/relatives consider you as a very nice person among all the people around them?

Yes No 

17.Do you always put emotional need of other people before yours?

Yes No 

18.Do you think love is more about caring for others than loving yourself?

Yes No 

19.Do you love others because you think it will help you in gaining recognition from them?

Yes No 



Section B

1.Do you often have difficulty with breathing?

Yes No 

2.Do you have chronic coughing or pain in your chest area?

Yes No 

3.Did you notice any changes in your fingernails – black spots, or lines, whitening and thickening around the edges, and clubbing?

Yes No 

4.Do you feel loss of appetite and feeling full lately?

Yes No 

5.Did you notice rapid and unexpected weight loss recently?

Yes No 

6.Do you frequently having stomachache or digestive pain?

Yes No 

7.Are you experiencing heavy or painful periods/bleeding in between cycles?

Yes No 

8.Have you noticed any changes in your nipple – looking flattened, inverted or turned sideways?

Yes No 

9.Is your breast red, sore or swollen?

Yes No 

10.Have you noticed pain in your lumbar spine or lower right side lately?

Yes No 

11.Have you noticed any puffiness, swelling or redness in your face?

Yes No 

12.Is there any bleeding from the rectum or blood in stool?

Yes No 

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