Functional Wellness Assessment
Congratulations on taking a step in the right direction for your long-term health, wellness and happiness!

This Online Assessment is very comprehensive, and it's vital that you answer all the questions so we can tally your Total Score and calculate your current Functional Wellness Results.

Please remember that it’s not important what your present starting point is... Like most people, you've probably been functioning in this state for quite some time, bringing you to the point where you consider the way you feel to be normal. Living in our demanding, time-urgent ‘survival mode' kind of world, we don’t know what we don’t know.

Dr Kevin will follow up with you by email within 72 hours after completion, and you're always welcome to send any other queries you may have direct to:

Please answer honestly and instinctively throughout Sections 2 - 7, because we're here to help you lead your healthiest, happiest and most terrific life!
Email address *
Name & Surname *
Email Address (to confirm you're a real human and not a bot!) *
Age *
City & Country *
Preferred Contact Number
Occupation *
Marital Status *
Height *
Weight *
Has your weight fluctuated by more than 2kg / 4.41 lbs over the last 3 years? *
Have you previously been diagnosed with any medical conditions such as diabetes, high blood pressure, etc? If YES, please provide details below: *
List any operations or important surgical procedures you've had, and in what year: *
Are you currently taking any chronic medication? If YES, please share the details and for what condition: *
Mailing List Opt-In: Would you like us to subscribe you to our email list so as to further enrich your life with Dr Kevin's latest newsletters and tips, promotions or special events? *
How did you hear about Dr Kevin's international Functional Wellness work? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy