Fitness and Health Survey

Explore your prospects' habits — energy levels, exercise routine, nutrition and weight goals — and spot who is open to a complimentary wellness consultation. A handy lead tool for nutrition and wellness advisors.

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How would you describe your energy levels?

High all day Good, with some dips Low in the afternoons Low most of the day

Would you like to improve your energy levels?

Comments

Do you exercise?

Yes, regularly Sometimes Rarely Never

What exercise do you do?

Walking Running Gym or weights Swimming Cycling Team sports Yoga or pilates

Would you like to improve your sports performance, fitness and stamina?

Do you suffer from health complaints, e.g. colds, flu, allergies, diabetes, blood pressure? Please list them plus any medicines

Do you feel you receive balanced daily nutrition from the foods you eat?

Would you like to...?

Lose weight Gain weight Maintain your weight Tone up Have more energy

How much would you like to gain or trim to reach your ideal weight?

Under 5 kg 5 to 10 kg Over 10 kg Not sure

If there were a way to lose, gain or maintain your weight while still eating the foods you love and improving your energy and performance, would you be interested in a FREE wellness consultation?

Name

Nombre

Apellido

Phone number

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