Hey There!

What’s your first name?

Nice to meet you, {what-s-your-first-name}!

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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