FREE Online Wellness Evaluation Questionnaire – how healthy & balanced is your diet? Find out today!

1. Do you have breakfast every morning? YesNo

2. Do you eat more meals with poultry, lean meat, fish and plant (soy) proteins rather than steaks, roasts and other red meats, including salamis & bacon? YesNo

3. Do you eat at least seven servings of a variety of colorful fruits and vegetables each day? YesNo

4. Do you consume primarily whole grains (100% whole wheat bread and pasta, brown rice) rather than regular pasta, white rice and white bread? YesNo

5. Do you eat ocean-caught fish at least 3 times a week? YesNo

6. Do you avoid eating fried foods, dressings, sauces, gravies, butter and margarine? YesNo

7. Is your digestive system free of indigestion or irregularity? YesNo

8. Do you get a minimum of 30 minutes of exercise 3-5 days a week? YesNo

9. Do you maintain a stable and appropriate weight? YesNo

10. Are your blood pressure, triglycerides and cholesterol in the normal range? YesNo

11. Do you usually have time to prepare balanced meals, rather than take aways or eating on the run? YesNo

12. Do you stay away from fizzy drinks, fruit juices and typical snack foods throughout the day and after dinner? YesNo

13. Do you consume less than 4 teas or coffees a day? YesNo

14.Are you free from cravings for sugars (sweets, cakes, biscuits, etc.) and other carbohydrates (crisps, toast, crackers, etc)? YesNo

15. Are you free of water retention or bloating? YesNo

16. Are you free from frequent colds and flu? YesNo

17. Do you maintain healthy and supple skin, free from dryness, psoriasis, acne or itchiness? YesNo

18. Do you always have the energy and focus you need to meet your daily challenges? YesNo

19. Do you drink at least 2 litres (women)/ 3 litres (men) of water per day? YesNo

20. Do you snack throughout the day? YesNo

21. Are you getting daily recommended amount of Calcium? (to get enough Calcium in your diet you need about 3 portion of dairy products each day (1 portion is a glass of milk) or plenty of other calcium rich foods like tofu, canned fish, green leafy vegetables, nuts and seeds) YesNo

22. Do you supplement with at least a high quality Multivitamin and Mineral each day? YesNo

23. Do you get ideally 7-8 hours of sleep per night? YesNo

24. Do you consume less than 14 units of alcohol per week? (equivalent to six pints of beer or seven glasses of wine) YesNo

25. Are you free from smoking? YesNo

26. Would you say that your stress levels are low most of the time? YesNo

27. What do you normally have for breakfast? (Choose one or more options you often have)
NothingCerealsToastsMuffinYoghurtFruit SmoothiesEggsProtein ShakesCoffee

28. What are your regular Snacking choices? (Choose one or more options you often have)
CrispsBiscuitsFruitCoffeeEggsYoghurtProtein barNutsDried FruitSandwich or Toast

Please fill in the basic information below so that your BMI and Protein Factor can be calculated and communicated back to you together with your wellness evaluation guide. Thank you.

Your Name

Your Email

Your Telephone Number

Your Gender
MaleFemale

Your Height

Your Weight

Your Age
Under 1819-2930-3940-4950-59Above 60

Please identify one or more of your Goals:
Manage WeightReduce Body FatIncrease Lean Muscle MassControl StressBoost Self EsteemIncrease Energy LevelsFeel HealthierLook BetterSleep BetterImprove DigestionImprove SkinUnderstand Nutrition Better

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