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Lifestyle Review Questionnaire

Home>Lifestyle Review Questionnaire
Lifestyle Review QuestionnaireViavi:be2019-01-14T11:46:28+00:00
  • Your name *

  • DD slash MM slash YYYY

  • Our role is to guide and coach you. We do not compare or judge, so please be honest.



  • 1 (Not at all) - 10 (Very much)

  • 1 (Not at all) - 10 (Very much)


  • 05. How keen are you to receive information and support on the following areas of your lifestyle?

    1 (No help wanted) - 10 (As much support as possible)


  • 07. Please summarise in the following areas how you have felt in the last 6 weeks

    1 (strongly disagree) - 10 (strongly agree)
  • Fitness and movement

  • Clinical nutrition

  • Energy recovery

  • Managing ageing


  • 08. Toxicity


  • If you suffer from any of the following, please tick if applicable:

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