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Your Wellness Check in!

• Description: Answer 5 quick questions about your daily habits. In under 2 minutes, you’ll get personalized insights—and a special offer to help you feel your best.


What is your full name?

How often do you feel physically energized throughout the day?

Do you get tired? Do you need coffee by 3pm?

How often do you feel physically energized throughout the day? Do you get tired? Do you need coffee by 3pm?
A
B
C
D

How would you describe your eating habits most days?

Are you crash dieting? Are you dieting all day and then getting the munchies at night?

How would you describe your eating habits most days?Are you crash dieting? Are you dieting all day and then getting the munchies at night?
A
B
C
D

Do you currently experience any recurring pain, tension or discomfort?

Do you currently experience any recurring pain, tension or discomfort?
A
B
C
D

How many days a week do you engage in physical activity for longer than 15 minutes?

How many days a week do you engage in physical activity for longer than 15 minutes?
A
B
C
D

If you could improve one area of your well being, what would it be first?

If you could improve one area of your well being, what would it be first?
A
B
C
D
E

Women- are you in perimenopause or menopause?

Women- are you in perimenopause or menopause?

Is there anything else I should know about of you have questions or concerns about (if nothing type NA)