This subjective questionnaire will give your health care practitioner a quick summary of symptoms or signs that may be related to bone health. It is not a substitute for professional medical advice from your health care provider. Do you have low bone density or osteoporosis?*YesNoDo you have a family history of osteoporosis? *YesNoHave you lost height?*YesNoDo you suffer from general poor health?*YesNoDo you take any long-term medications known to increase the risk of osteoporosis (e.g., corticosteroids, heparin, anti-seizure medications)? *YesNoDo you suffer from immobility? *YesNoDo you have hyperparathyroidism or hyperthyroidism?*YesNoDo you have a gastrointestinal issue that causes malabsorption?*YesNoDo you consume excess caffeine or alcohol? *YesNoDo you smoke? *YesNoIs your diet low in calcium? *YesNoDo you live a stressful lifestyle? *YesNoDo you have low vitamin D intake and limited sun exposure? *YesNoAre you a woman with a thin or small body frame?*YesNoAre you a woman with ammenorhea (loss of the menstrual period)?*YesNoAre you a woman with low estrogen levels?*YesNoAre you a postmenopausal woman?*YesNoName* First Last Phone*Email*