Health & Wellness Questionnaire
Hey there,

Thank you for taking the time to fill in this questionnaire. We're looking forward to seeing your responses.

As a thank you I will email you a free PDF on 4 key areas to Make a Healthy Active Lifestyle YOUR new normal.  This is not automated so please allow up to 48 hours to receive your email.

And of course you are invited to come join us for lunch at our Smoothie Club - let me know if you'd like an invite.

Yours in health

Helen

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Email *
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Name *
Phone Number *
How would you describe your current lifestyle? *
Do you feel you receive balanced nutrition daily from the foods you eat? *
Do you experience a loss of stamina during the day? *
Do you feel that any health concerns you may have are affected by, or related to, your diet? *
Do you know the importance of knowing your body fat percentage and your visceral fat rating? *
To be your preferred weight what do you believe need to do? *
How have you tried to reach your preferred weight in the past? *
Do you take nutritional supplements? *
If yes, what supplements do you use, or have used in the past? *
How important is it to you to achieve your health and wellness goals? *
Not important at all
Extremely important
How committed are you to making the necessary changes to improve your health and well-being?
Not Committed at all
Extremely Committed
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Check all that apply *
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We have different options to assist you in achieving your health and wellness goals.  Please tick all the options you would like more information on. *
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