Assessment

First name

Last name

Phone

Email

Birthday

Section 1: GENERAL HEALTH

1. What is your age range?

2. How would you rate your overall health?

Excellent

Good

Fair

Poor

3. Do you have any known health conditions? (Check all that apply)

Section 2: Energy & Mood

1. How would you describe your energy levels throughout the day?

High and steady

Moderate but consistent

Low with occasional dips

Low energy most of the time

2. Do you often experience mood swings, stress, or anxiety?

Yes, frequently

Sometimes

Rarely

Never

3. How do you usually handle stress?

I manage it well

I can handle some, but get overwhelmed at times

Stress often negatively affects me

Stress is a major concern for me

Section 3: Digestive Health

1. Do you experience any of the following digestive issues? (Check all that apply)

2. How often do you consume processed or fast foods?

Daily

3-5 times per week

1-3 times per week

Rarely

3. Are you looking to support specific areas of your digestive system?

Yes, I need support for digestion

No, my digestion is generally fine

Section 4: Goals & Preferences

1. What are your primary health goals? (Check all that apply)

2. Are you looking for a specific type of supplement?

3. Do you have any dietary restrictions or preferences?

Vegan/Vegetarian

Gluten-Free

Dairy-Free

Other

Section 5: Lifestyle & Activity Levels

Weightlifting or resistance training

Cardio (running, cycling, swimming, etc.)

Yoga or Pilates

Team sports (soccer, basketball, etc.)

Low-impact (walking, stretching, etc.)

I’m mostly sedentary

2. How important is muscle recovery in your routine?

Very important, I focus on muscle recovery after workouts

Somewhat important, I try to recover but could improve

Not a priority, I don’t focus on recovery

3. How much protein do you consume daily (from food or supplements)?

I actively track my protein intake and hit my target

I try to eat enough protein, but don’t track it closely

I don’t focus on protein intake

4. Are you looking for a supplement that supports physical performance or endurance?

Yes, I need something for better workouts and stamina

No, my performance levels are fine

Not sure, open to recommendations

Location

Phone

Email

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