Q2: Have you ever been told you have high blood pressure or diabetes?

Yes

No

Cellular Clearance & Autophagy

Q3: How often do you practice fasting (skipping breakfast, time-restricted eating, or longer fasts)?

Never

Occasionally

3–5 times per week

Daily

Q4: How often do you eat packaged or processed foods (chips, cookies, frozen meals, fast food)?

Daily

3–4 times per week

1–2 times per week

Rarely/Never

Brain & Neuro-Clearance

Q5: On average, how many hours of restful sleep do you get per night?

<5 hours

5–6 hours

6–7 hours

7–8 hours

Q6: Do you usually wake up feeling mentally clear and refreshed?

Never

Sometimes

Often

Almost Always

Toxin & Burden Load

Q7: How many servings of alcohol do you typically drink per week?

10+

5–9

1–4

0

Q8: Do you drink at least 8 glasses (2 liters) of water daily?

Rarely

Sometimes

Often

Always

Metabolic & Cardiometabolic Health

Q9: Has a doctor ever told you that you have high blood sugar, prediabetes, or diabetes?

Yes

No

Q10: How often do you engage in at least 30 minutes of physical activity (walking, gym, cycling, sports)?

Rarely/Never

1–2 times per week

3–4 times per week

5 or more times per week

First Name

Last Name

Email *

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