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Survey Form

Are you motivated to improve your lifestyle and daily habits?(Required)
Are you ready to meet the new you in 3 months?(Required)
Have you ever had cancer or are you currently recovering from cancer treatment?(Required)
Have you been diagnosed with a thyroid autoimmune condition such as Hashimoto’s or Graves’?(Required)
Have you been diagnosed with a serious mental health condition (e.g., schizophrenia, bipolar disorder, severe depression requiring medical supervision)?(Required)
Do you experience significant mobility or movement limitations in daily life?(Required)
Have you been diagnosed with a cardiovascular condition (e.g., heart disease, arrhythmia, hypertension requiring medication)?(Required)
Do you have any serious speech or hearing impairments that could limit communication during coaching?(Required)
Are you under 18 or over 75 years old?(Required)
Have you been advised by a medical professional to avoid changes in diet, supplements, or physical activity without supervision?(Required)
Are you currently taking medication for a serious psychiatric or neurological condition?(Required)
Have you been diagnosed with an autoimmune disorder that affects major organs (e.g., lupus, multiple sclerosis)?(Required)
Are you currently suffering from a serious respiratory condition (e.g., COPD, severe asthma)?(Required)
Are you currently dealing with a severe metabolic condition (e.g., uncontrolled diabetes)?(Required)
Are you seeking guidance on nutrition, supplements, activity, and overall lifestyle improvement?(Required)