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FREE Vital Survey - How are you really doing?
n this test you can find out where the problem is and where you can start! Enjoying life, feeling comfortable in your own skin - that is quality of life. Do your vitality survey for yourself. *Your personal data will be protected according to GDPR!
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* Indicates required question
Email
*
Your email
Do you have problems with your digestion, stomach or intestines? *
*
Not at all
1
2
3
4
5
Very
Are there foods that you cannot tolerate? *
*
Yes
No
Do you tend to impure skin? *
*
Yes
No
Are you prone to colds or infections? *
*
Yes
No
Do you often feel tired and listless? *
*
Yes
No
Do you find it difficult to concentrate for a long time?
*
Yes
No
Do you often suffer from headaches?
*
Yes
No
Are you sometimes depressed for no reason?
*
Yes
No
Are you often irritable?
*
Yes
No
Having trouble falling asleep?
*
Yes
No
Do you wake up in the morning not really rested?
*
Yes
No
Do you often feel stressed?
*
Yes
No
Are you satisfied with your skin, hair, nails?
*
Yes
No
Do you eat less than 5 servings of fresh fruit, vegetables or salad daily?
*
Yes
No
Do you have experience with dieting?
*
Yes
No
Would you like to lose weight
*
Yes
No
How much weight would you like to lose?
5kg
5kg - 10kg
10kg or more
Clear selection
How much is your health worth to you per day?
*
3,50€
4,50€
6€
or more
Your name:
*
Your answer
Phone number
*
Your answer
Preferred contact method
*
WhatsApp
Telephone
Required
Data protection:
Your personal data will only be used to contact you and cannot be viewed by third parties. If you wish, you can request the deletion of the data you have provided at any time. Please contact the following email address: nicole@betterlifebalance.de
A copy of your responses will be emailed to the address you provided.
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