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HOW HEALTHY ARE YOUR EATING HABITS?
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Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
How many servings of fruits and vegetables do you eat daily?
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None
1-2 servings
3-5 servings
5-7 servings
How many hours do you sleep per night?
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Less than 5 hours
5-6 hours
7-8 hours
More than 8 hours
How many balanced meals do you consume per day? (Includes all macronutrients carbs, protein, fat)
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1 balanced meal
2 balanced meals
3 balanced meals
More than 3 balanced meals
How often do you snack between meals?
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Never
Sometimes
Frequently
Every day
How often do you exercise?
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Never
1-2 times per week
3-5 times per week
5-7 times per week
WHICH OF THE ABOVE OPTIONS DO YOU FEEL YOU STRUGGLE WITH THE MOST AND WHY?
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ARE YOU LOOKING FOR HELP WITH YOIUR HEALTH AND FITNESS GOALS?
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Yes
No
Submit
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