Health & Wellness Questionnaire
Thank you for taking the time to fill in this questionnaire. We're looking forward to seeing your responses.
As a thank you I will email you a free PDF on 4 key areas to Make a Healthy Active Lifestyle YOUR new normal. This is not automated so please allow up to 48 hours to receive your email.
And of course you are invited to come join us for lunch at our Smoothie Club - let me know if you'd like an invite.
Yours in health
How would you describe your current lifestyle?
Do you feel you receive balanced nutrition daily from the foods you eat?
Do you experience a loss of stamina during the day?
Do you feel that any health concerns you may have are affected by, or related to, your diet?
Do you know the importance of knowing your body fat percentage and your visceral fat rating?
What is Visceral fat?
To be your preferred weight what do you believe need to do?
How have you tried to reach your preferred weight in the past?
Do you take nutritional supplements?
If yes, what supplements do you use, or have used in the past?
How important is it to you to achieve your health and wellness goals?
Not important at all
How committed are you to making the necessary changes to improve your health and well-being?
Not Committed at all
Check all that apply
I want to LOSE body fat
I want to GAIN lean muscle
I want to IMPROVE my energy levels
I want to have more QUALITY sleep
I want to REDUCE my health risks (e.g. heart disease, diabetes, stroke, some cancers, osteoporosis)
I want to IMPROVE my Immunity
I want a SIMPLE strategy to achieve my health & wellness goals
We have different options to assist you in achieving your health and wellness goals. Please tick all the options you would like more information on.
6 Week Body Transformation Challenge (Online for New Zealand and Australia)
4 Week Weight Loss Challenge (Online for New Zealand and Australia)
4 Week Fit Challenge (Lower Hutt)
I'd love an invite to Smoothie Club (Lower Hutt)
I'd love an invite to sample the shakes (free - Lower Hutt)
I'd love an invite to sample the skin care range (free - Lower Hutt)
10 Day Detox (worldwide)
Nutrition Support Programs (Personalized to you - worldwide)
Give me access to a 17 minute video - info on the nutrition range and results people are getting.
How to Manage, Reduce, Eliminate chronic pain using medication free strategies
Optimise sports performance and recovery
How to optimise your health & wellness and earn an additional $500 - $1,000 per month part time
How to optimise your health & wellness and earn an additional $1,500 - $2,500+ per month
Send me a copy of my responses.
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