Health Survey
If you struggle with lowering your cholesterol or are pre-diabetic, please help me gather some more data to help clients more effectively.
Age *
Occupation *
Marital Status *
Medical Issues (check all that apply) *
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Frequent Symptoms (check all that apply) *
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What have you tried in the past to lower your cholesterol? (check all that apply) *
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What kind of supplements have you tried to lower your cholesterol? *
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Were you successful in lowering your cholesterol? *
Are you worried about your cholesterol level and heart health? *
What have you tried in the past to fix your pre-Diabetes? (check all that apply) *
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What kind of supplements have you tried to lower your blood sugar? *
Were you successful in lowering your blood sugar? *
Are you worried about your pre-diabetes? *
What do you think your health will look like in 5 years if you do not work on improving your cholesterol? *
What do you think your health will look like in 5 years if you do not work on improving your blood sugar? *
How quickly do you think you can resolve your high cholesterol or high blood sugar? *
What kind of tools would you need to make your health improvements? *
How is having high cholesterol affecting your emotional health? *
How is having pre-diabetes affecting your emotional health? *
If there was a magic pill to fix your health problem(s), what issue(s) would it fix for you? *
How do you feel about food in social settings or when eating out? (check all that apply) *
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Lets switch gears!      What are some of your hobbies? *
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Favorite Department Stores to shop? *
Favorite Clothing stores to shop *
Favorite Grocery Stores to shop? *
Favorite Items to shop for? *
Favorite music genres *
Favorite cuisine to eat out *
Favorite cuisine to cook *
Favorite desserts to make *
Favorite snacks to make/buy *
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