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Elaina’s Wellness Quiz
Beauty starts from within!
Thanks for taking my wellness quiz! Please make sure to fill out all of the
questions and enter a point of contact so I can get back to you with your results!
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Name:
Your answer
Do you eat 3 or more meals a day?
Yes
No
Other:
Clear selection
Do you eat fruits & veggies daily? If not, how often?
Yes
No
Other:
Clear selection
Do you take a multivitamin?
Yes
No
Other:
Clear selection
Are anti-aging ingredients important to you?
Yes
No
Clear selection
Digestion concerns/ issues?
Yes
No
Hormonal acne?
Yes
No
Clear selection
Do you have trouble falling asleep at night?
Yes
No
Other:
Clear selection
How many hours of sleep do you get at night?
4-5
6-7
8+
Clear selection
Does stress/ anxiety keep you awake?
Yes
No
Other:
Clear selection
How often do you drink coffee?
Daily
A few times a week
Other:
Clear selection
Do you have any allergies?
Your answer
Are you currently taking any supplements? If so, what?
Your answer
What are you looking for your nutrition supplements to help improve?
Your answer
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