Hygieia Wellbeing Quiz

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Our Nutrition Coach will review your quiz and put together recommendations for you. Recommendations for nutrition, supplements, and wellbeing will be emailed to you. Visit our store at HygieiaWellbeing.com

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Email *

First and Last Name *

Age range *

under 16 years

16 years- 18years

18 years- 30 years

30 years- 40 years

40 - 50 years

50- 60 years

over 60 years

Gender *

Female

Male

Prefer not to say

What areas would you like to get recommendations for? (you may choose more than one) *

General wellbeing/ health

increased energy level

losing weight

gaining weight

maintaining weight

increased strength

managing sugar levels

cardiovascular/ heart health

immune support

bone health

eye health

joint health

hair and skin

healthy aging

control pre- menopause symptoms

control menopause symptoms

work out supplements

sleep better

feel better/ better mood

relaxation

anxiety

focus

memory

Other:

Required

Do you have allergies? (you can check more than one) *

none

seasonal

soy

cow"s milk

nuts

gluton

shellfish

fish

wheat

Other:

Required

Do you have any dietary restrictions/ special diet? *

none

vegan

vegetarian

specific carbohydrate diet (scd)

low fodmap

keto

gluten free

kosher

Other:

Required

How active are you? *

do not exercise at all

light exercise such as walking for 30 minutes 3 to 7 times a week

moderate exercise such as exercise class or physical activity a few times a week

intense exercise such as hiit, weights, aerobic activity 30 minutes 4 or more times a week

How many cups of vegetables do you have a day? *

0 cups

0 to 1 cup

1 to 2 cups

2 to 3 cups

3 to 4 cups

Other:

How many cups of fruit do you have a day? *

0 to 1 cup

1 to 2 cups

2 to 3 cups

3 to 4 cups

How active is your job? *

sit most of the day

move between sitting and walking

pretty active, standing and rarely sitting, lifting, moving around most of the time

very active with heavy lifting and constant movement

Other:

How many meals do you have a day? *

4-5

5 or more

Do you eat snacks between meals? *

yes

How many hours of sleep do you get in a day? *

less than 5 hours

5 to 6 hours

7 to 8 hours

more than 8 hours

Are you currently taking any supplements or vitamins? If yes, please list them. *

Do you understand this questionnaire is to give recommendations to improve your health and are appropriate for most healthy individuals. We do not give medical advice. Always check with your doctor before starting a new supplement, diet, or exercise regimen for safety. *

yes

Follow hygieiawell on Instagram and receive a free gift. Choose your free gift. *

Mushroom Coffee Fusion

Sleep Well Gummies

What is your shipping address for your free gift? (Needs to be in the United States) *

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