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!
Sign in to Google to save your progress. Learn more
Email *
Do you have problems with your digestion, stomach or intestines? *
*
Not at all
Very
Are there foods that you cannot tolerate? * *
Do you tend to impure skin? * *
Are you prone to colds or infections? * *
Do you often feel tired and listless? * *
Do you find it difficult to concentrate for a long time? *
Do you often suffer from headaches? *
Are you sometimes depressed for no reason? *
Are you often irritable? *
Having trouble falling asleep? *
Do you wake up in the morning not really rested? *
Do you often feel stressed? *
Are you satisfied with your skin, hair, nails? *
Do you eat less than 5 servings of fresh fruit, vegetables or salad daily? *
Do you have experience with dieting? *
Would you like to lose weight *
How much weight would you like to lose?
Clear selection
How much is your health worth to you per day? *
Your name: *
Phone number *
Preferred contact method *
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.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report