2. How many push-ups can you do consecutively? *

0–5

6–15

16-30

31+

3. How many pull-ups can you do consecutively? *

0

1-3

4-7

8+

4. Can you get up from lying flat without using your hands? *

No

Only with difficulty

Easily

5. How many days per week do you exercise? *

0

1-2

3-4

5+

6. Do you stretch or do yoga weekly? *

Never

Occasionally

Weekly

Daily

7. How would you rate your current energy level? *

Very low

Low

Moderate

High

8. Do you experience chronic pain or stiffness? *

Frequently

Sometimes

Rarely

Never

9. How many hours of sleep do you get? *

<5 hrs

5–6 hrs

7–8 hrs

8+ hrs and feel rested

10. How clean is your diet? *

Fast food and soda often

Processed food daily

Whole foods sometimes

Whole foods mostly

11. How often do you consume sugar? *

Daily

4–6x/week

1–3x/week

Rarely/Never

12. How often do you drink alcohol? *

Daily

A few times/week

Occasionally

Rarely/Never

13. Do you smoke or vape? *

Yes

Former smoker

Occasionally

Never

14. Do you take daily health supplements? *

Never

Occasionally

Sometimes

Daily routine

15. Do you track biomarkers (biological age, labs, etc.)? *

Never

Once or twice

Annually

Quarterly+

16. Do you fast (16+ hrs) regularly? *

Never

Rarely

Occasionally

Weekly

17. Have you done a 3-day cleanse or detox before? *

Never

Once

2–3 times

4+ times

18. How many prescription meds do you currently take? *

5+

3–4

1–2

None

19. How often do you feel bloated, foggy, or sluggish? *

Daily

Few times/week

Rarely

Almost never

Full Name *

Phone *

Email *