1 .
Contact Information (Confidential)
Name
Email
2 .
On a scale from 1-10, how would you rate your health?
3 .
What is your current health-related goal?
4 .
What is your favorite meal of the day?
5 .
What is your least favorite meal of the day? (or the one that life makes you skip the most)
6 .
Do you drink water?
7 .
Do you currently suffer from an ongoing medical condition?
8 .
Are you worried about any potentially inherited medical conditions?
9 .
How many hours of sleep do you average per night?
10 .
Do you exercise regularly?
11 .
Do you currently take any vitamins or supplements?
12 .
Describe your typical day from a nutritional standpoint.
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13 .
Would you like to learn more about living a healthy life and how it can benefit your work?