Upgrade Your Health Questionnaire

Relating to health and fitness habits in the morning: When you wake, you

Eat Breakfast
Have coffee
Exercise first
Exercise after eating
Other:

Comments:

If you eat breakfast, what does it usually consist of

Check off and list any health problems you are experiencing

Stress can show up in many ways in our bodies: if you check off stress, explain in comments

weight gain
skin rashes
digestive pains
joint pain
excessive tiredness
stress
Other:

Comments:

List what you eat for breads, cereals, snacks, meats, beverages, dairy, Include brands, if possible. *

How often do you eat? *

Do you want help establishing a supplement routine designed with your needs in mind? *

Do you exercise? If so what do you do? *

What do you think can be gained by learning what's best for your body and possibly adding nutritional supplements *

Feel Better overall
See a gradual change in certain health issues I've been experiencinggg
Satisfaction of knowing I could be adding years to my life
Motivation to take on physical work I didn't think I could before
Increased knowledge on meals and snacks to make for my family
Increased desire to learn simple truths about health
Other:

Comments:

Would you like an inexpensive video chat to help get you on track to improve your current health condition? If so, leave your contact information below and we will be in touch. *

Transformation Health and Fitness 774-283-0791. Contact: Charlene Ryan
The above answers will help us better assist your specific needs. we want to see where you're at before proceeding. Your first fee will not be more than $50 and you will be able to start implementing the necessary changes for improved health. Follow up appointments may be needed.

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