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? * Yes No Do you eat three meals a day? * Yes No Do you experience a loss of energy during the day? * Yes No Do you think you need to lose weight? * Yes No Do you think you need to gain weight? * Yes No Do you want to just maintain your weight? * 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? * Yes No If yes, which ones? Are you interested in finding out more about nutrition for sport? * Yes No Which sports do you participate in and how often? Are you interested in finding out more about energy products? * 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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