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Gordons' Questionnaire

In: Science

Submitted By scollins0522
Words 324
Pages 2
429-0101
Grand Canyon University

Gordon’s Functional Health Questionnaire

Health Perception and Values
What is your opinion on alcohol consumption and tobacco use in your family?
How important is it for your family to get yearly health exams?
Nutrition and Metabolism
With regards to your nutritional beliefs, would you rather eat at home or out? Why?
How much thought during your meal preparation do you place on the nutritional value of the meal?
Sleep and Rest
Do you make it a priority to get at least eight hours of sleep? If not, why?
Can you describe your sleep habits? Do you wake up during the night frequently or sleep undisturbed.
Elimination
Explain if you have any bowel problems including black or bloody stools, constipation or diarrhea.
Explain any urinary problems including frequency, difficulty or painful urination.
Activity and Exercise
How important is exercise to your family?
How much time do you devote to daily physical activity?
Cognitive
Have you notice any change in your memory or recollection of daily events? Explain.
Have you noticed any problems processing and retaining information at work school or even while having social conversations?
Sensory Perception
Describe any decreased or heightened sensitivity in regards to your senses? This may include your hearing, touch or taste?
Describe any difficulty in your ability to recognized any objects, shapes or colors?
Self- Perception
Tell me what you see when you look in the mirror.
How does what you see in the mirror make you feel?
Role Relationship
What is the primary role for each family member?
What is your primary role in the community?
Sexuality
Explain what an active sexual relationship means to you in your marriage.
How do you make time for intimacy with full time jobs and busy social schedule?
Coping
What coping mechanism do you utilized to minimized stress?
What professional or personal support system do you rely on most to comfort you during periods of increased stress?…...

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