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English (and other languages) speakers often use "How are you?", "What's up?", "How's it going?" and similar phrases as greetings. Other language speakers and cultures will refrain from asking such a question unless they are genuinely interested in the answer and have a reason to ask, so typically not as part of greeting someone.

Is 「お元気ですか」 acceptable to use in a similar way, such as greeting someone with 「おはようございます。お元気ですか。」?

If it is, how common is it?

Does it sound weird to native speakers?

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It is weird if it's the first phase you open with. First you need an opener. If you're a guy you might say, おい、元気? ("Oi" or オッス "Ossu" is not really a word, it's more like a sound, or like "hey!" preceding a "what's up" in English.) But just like "what's up, this is between pals, casual not for your big boss or strangers. Women tend to say 久しぶり、元気?or even a cute ハイハイ! 元気? There are many different combos, but I've never heard a conversation just start with straight up "Genki?"

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