Health and Lifestyle Survey
How would you describe your lifestyle?
*
Do you think you eat 100% of the daily nutrition you need for good health?
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Yes
No
Do you eat three meals a day?
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Yes
No
Do you experience a loss of energy during the day?
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Yes
No
Do you think you need to lose weight?
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Yes
No
Do you think you need to gain weight?
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Yes
No
Do you want to just maintain your weight?
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Yes
No
How much weight do you want to lose/gain?
Why do you want to lose/gain weight?
Have you tried diet programmes in the past?
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Yes
No
If yes, which ones?
Are you interested in finding out more about nutrition for sport?
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Yes
No
Which sports do you participate in and how often?
Are you interested in finding out more about energy products?
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Yes
No
Are you interested in finding out more about skin care products?
*
Yes
No
If you would like a well-being check, please tell us your height and weight:
Please fill in your contact details (name, email, phone)
*
When is the best time to phone you?
Would you like more information sent to you by email?
Yes
No
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