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Health Quiz
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SPRING2022
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Is avoiding diabetes your top health priority right now?
Yes
No
Would you say you have a good understanding of how different foods affect your blood sugar, and what you should do to stay in range?
Yes
No
Have you put a lot of work into a long-term goal to lose weight, maintain your weight, or increase your energy level?
Yes
No
Have you already found what works for you, and do you manage to stick to it without too many ups and downs?
Yes
No
What's your gender?
Male
Female
Non-Binary
Prefer Not To Disclose
What's your age?
18-30
31-40
41-50
51-60
61-70
71-80
81+
What's your height?
What's your weight?
How much weight are you planning to lose?
I'm not interested in weight loss
5 lbs
5-10 lbs
10-15 lbs
15-20 lbs
20-25 lbs
25-30 lbs
More than 30 lbs
I’d like to avoid gaining weight
Do you have any chronic conditions?
Diabetes
Hypertension
PCOS
Hashimoto's
Prediabetes
Other
None
Please specify
Has someone in your family had diabetes?
Yes
No
Do you feel exhausted after meals?
Yes
No
Sometimes
What type of coaching style do you prefer?
Friendly: Someone I can really open up to
Motivator: An encouragement who will keep me going
Tough-love: Someone to challenge and push me
Educator: Give me my to-do’s and let me take it from there
Peer: Someone to bounce ideas around with
We're almost there. Let's save your results to move forward. We can't wait to help you optimize your health!
Full Name
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Email
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Gathering Data
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