Nutrition Club health survey
Thankyou for taking the time to complete our survey
Full Name
Phone
*
Date of birth
Email
*
Do you eat breakfast everyday?
Yes
No
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Do you exercise on a regular basis?
Yes
No
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Do any of the below statements apply to you?
I am an emotional eater
I Struggle with a lack of energy
I often feel bloated and uncomfortable
I binge eat
I struggle with motivation
I struggle to lose weight
Do you have any specific health/wellness goals for? (eg:- Increase energy, better sports endurance, lose weight, gain muscle mass)
What are your biggest challenges when it comes to achieving your health/wellness goals? (eg:- time, work, finances, motivation)
If we could help you to achieve any of the below, would you be ready to commit to improving your health and wellbeing? - Increased energy - More motivation -Weight loss - Improved confidence -Better sleep -A better relationship with food - A better understanding of basic nutrition
Yes please tell me more
I'm not quite ready to commit the time to improving my health and well being
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