.
My Health Check 💪🏻
show me your health situation - I'll show your way to a better future 💖
Start
Secured
Survio
1
What's your Name
2
How are you feeling at the moment?
How do you feel? How much energy do you have right now?
3
How many liters of water do you drink every day?
Only water, no other beverages.
less than 1 liter
1-2 liter
more than 2 liter
4
How often do you exercise each week?
Select one or more answers
almost never
1-2 times a week
3-4 times a week
Every day
5
Do you consume caffeine to boost your performance/energy?
Select one or more answers
No, not at all
Yes - Coffee
Yes - Energy drinks
Yes - booster fitness drinks
Yes - tablets
6
Do you suffer from headaches or even migraines?
Select one or more answers
Yes
No
Sometimes
I know someone who does
7
Do you suffer from concentration problems?
Select one or more answers
Always
Sometimes
No, not at all
I know someone who does
8
Do you suffer from joint pain and/or tension?
Select one or more answers
sometimes
No, not at all
9
Do you have skin problems/blemishes?
Select one or more answers
Yes, sometimes
No, not at all
10
Do you suffer from hair loss?
Select one or more answers
Yes
No
11
Do you have problems with your scalp? Psoriasis or eczema?
Select one or more answers
Yes, sometimes
No, not at all
12
Do you suffer from intestinal and digestive problems?
Select one or more answers
Yes, sometimes
No, not at all
13
Do you often feel tired or exhausted?
Select one or more answers
Yes, very often
Sometimes
No, not at all
14
Are you currently taking supplements to combat vitamin deficiency?
Select one or more answers
Yes
No
15
How often do you get sick during the year?
Select one or more answers
Never
1-2 times
3-4 times
More than 5 times
16
Do you have any intolerances, sensitivities, or allergies?
If yes, please write down
17
How satisfied are you with your body/weight right now?
18
How much is your health and well-being worth to you per month?
incl. food, exercise, mental health, etc.
it's not that important to me
50-70
70-120
120-150
more than 150
19
Which WhatsApp number (including area code) can I reach you at once I've evaluated your survey?
I look forward to hearing from you :) Thank you!
Submit