Health And Lifestyle Survey

Which of these words best describes your own lifestyle?

Calm Active Stressed

Do you think you get 100% of the daily nutrution needed for good health?

Yes No Sometimes

Do you take nutritional supplements (vitamins / minerals / proteins)?

Daily Never Sometimes

Do you experience a loss of energy during the day?

Yes No Occasionaly

Do you, or does any member of your family or friends need to lose, gain or maintain weight?

Lose weight Gain Weight
Maintain Weight Can't say for certain

Approximately how much weight do you/they need to lose or gain?

Have you tried diets in the past?

Yes No
Which ones?

Do you eat a variety of healthy foods from the basic food groups every day?

Yes No

If not, why not?

Not enough time for shopping / preparation
Too expensive
Too complicated

Are you interested in learning about a nutritional programme to control weight while still eating the foods you like, without feeling hungry?

Yes No

Would you prefer further information to be sent to your email address?

Yes No