HEALTH ANALYSIS | healwellness

What is your age group?

In order to make individual recommendations, please select your top health priority from the folowing list?

If one of your top priorities is Weight Loss, how much weight would you like to lose?

How would you rate your level of commitment to accomplishing your goal?

High

Moderate

Low

Have you been on a Diet Program before?

YES

NO

If you have been on a diet program before, have you managed to maintain the weight loss?

YES

NO

How much fruit do you eat on a day to day basis?

1

2+

Nil - I dont eat fruit

How many of servings of Vegetables would you eat daily? e.g. 1 serving = 1 potato, 5 cherry tomatoes, 1 whole carrot etc...

1

2

3+

Do you eat processed/ packaged foods?

YES

NO

How often do you eat processed/ packaged foods?

Rarely

Occasionally

Often

Do you eat takeout or dine out at restaurants?

YES

NO

How many glasses of water would you drink per day? (glass size = 200ml)

Is this water tap or filtered?

YES

NO

Do you drink any of the following? Soft Drink - Coffee - Black Tea - Energy Drinks - Fruit Juice - Alcohol

YES

NO

Are you conscious of the toxins you consume and absorb each day?

YES

NO

Are you active or do you exercise?

YES

NO