Healthy Habits Assessment
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Rate your current Health habits/choices *
Poor
Excellent
How well do you hold yourself accountable? *
Are you able to motivate yourself? *
When it comes to being committed to something, is self-support sufficient or is outside support needed? *
Rate your daily stress levels *
Low
High
Would you like to reduce your stress levels? *
Rate your energy levels *
Low
High
Would you like to improve your energy levels? *
Rate your sleep quality *
Poor
Excellent
Would you like to improve your sleep quality? *
Do you have hormonal imbalances? Weak skin/hair/nails, mood swings, irritability, weight loss struggles/weight gain etc... *
Would you like to improve your hormonal balance?
Clear selection
What is your main goal? *
Required
What is holding you back from reaching this goal/s? *
What would your life be like if you were to reach this goal/s? *
Would you be interested in improving your health, reaching goals, being held accountable, staying motivated, having daily support, having amazing energy levels, sleeping like a baby, reducing stress levels, and just feel amazing overall? *
If you would like a free consultation, then please leave your name and E-mail. We'll be happy to reach out. Thank you for completing our questionnaire.
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