Mini HLS Health Assessment

Email Address *

First Name

Last Name

Do you currently eat breakfast, lunch & dinner?

Are there long gaps between meals?

Are your meals:

Do you have any particular cravings like:

And why do you think you may have cravings?

How much water do you drink daily?

What is the source of your water?

How much straight thru sleep do you get on average

Have trouble sleeping & keeping a sleep schedule?

YES NO

How much exercise do you get on average daily?

Type of exercise & what is your favorite type?

Do you have a lot of stress in your life?

YES NO

Do you have noise & a lot of commotion around you?

YES NO

Interested in changes to health, body & lifestyle?

YES NO

Describe your number one challenge.