1
What is your name?
Choose answer which describes you most
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What is your name?
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2
Which of these would you be most interested in?
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Which of these would you be most interested in?
Making healthier choices
Going down a size or two
Gaining weight
Getting some needed nutrients
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3
What is your age?
Never too young or too old
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What is your age?
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4
How you identify yourself?
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How you identify yourself?
Male
Female
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5
How have you been feeling lately?
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How have you been feeling lately?
Meh
I get around
Awesome
Not so good
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6
What are you struggling with?
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What are you struggling with?
Stress
Trouble sleeping
Lack of energy
Focus and mindfulness
Sex/libido
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7
How do you feel after you wake up?
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How do you feel after you wake up?
Refreshed and ready for the day
More often ok than anything else
Don't talk to me until I've had coffee
I just want to stay in bed
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8
How are your energy levels during day?
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How are your energy levels during day?
Pretty low
A mix of ups and downs
Pretty high
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9
Are you easily distracted?
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Are you easily distracted?
Easily...look a cute dog...
Focused for about an hour or two
Sharply focused
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10
What are your stress levels during the day?
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What are your stress levels during the day?
If I'm breathing, I'm stressed
A roller coaster with ups and downs
I manage
Im cool
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11
Do any of these medical conditions apply to you?
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Do any of these medical conditions apply to you?
Low immune system
Diabetes
Digestive problems
None apply
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12
How do you describe your activity level?
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How do you describe your activity level?
Hardcore
Very active
So, so
Not really
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13
Would you like to do this juice fast or meal program with a partner?
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Would you like to do this juice fast or meal program with a partner?
Yes
No
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14
What are your eating preferences?
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What are your eating preferences?
Keto (meat)
Keto gluten free (meat)
Vegan
Vegetarian
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15
What is your height in cm?
Not too low but no too high
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What is your height in cm?
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16
What is your weight in kg?
Not too light but no too heavy
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What is your weight in kg?
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17
What is your email?
Special program is coming your way
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What is your email?
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So pleased to see you accomplishing great things
So pleased to see you accomplishing great things