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What’s your first name?
Nice to meet you, {what-s-your-first-name}!
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What’s your e-mail?
So we can save your answers.
Are you:
Male
Female
How old are you?
What is your current weight?
In lbs
What’s your height?
FT
IN
Is your waist circumference greater than 34 inches?
Yes
No
Do you experience high levels of stress?
Yes
No
Have you been diagnosed with Type 1 Diabetes?
Yes
No
Any heart concerns?
Cholesterol
Blood Pressure
Neither
Do you have trouble sleeping at night?
Yes
No
Do you feel burnt out or fatigued?
Yes
No
In an average week, you eat fish or seafood:
Never
Once or twice
Three or more times
In an average week, you eat meat:
Never
Once or Twice
Three or more times
On an average day, you eat fruits and vegetables:
Rarely
Once or Twice
Three or more times
On an average day you eat dairy:
Common examples include milk, yogurt and cheese.
Rarely
Once or Twice
Three or more times
In an average week you exercise:
Rarely
Once or Twice
Three or more times
Do you gain weight easily?
Yes
No
If you gain weight it goes straight to:
Your belly
Waist down
All around
Do you experience shortness of breath during physical activity?
Yes
No
Last question! How did you hear about us?
This won't affect your recommendation
From a friend
Article or Blog
Facebook
Instagram
Podcast
Mail
Online Search
Other
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