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Smoothie Ingredients

We're Here to Help You on Your Wellness Journey

Personal Information:

Birthday

Health Information:

Medical Conditions:
Do you take any medication regularly?
Yes
No
Do you have any dietary restrictions?
Yes
No

Lifestyle Information:

How many meals do you eat per day?
1
2
3
More than 3
How often do you exercise?
Rarely
1-2 times a week
3-4 times a week
5+ times a week
On average, how many hours of sleep do you get per night?
Less than 5
5-7
8 or more

Goals and Expectations:

What are your primary health goals?
How motivated are you to make dietary changes?
Very motivated
Somewhat motivated
Not Sure
Share your activity Level
Sedentary (Little or no Exercise)
Light Exercise (1-3 times a week)
Moderate Exercise (3-5 times a week)
Active (Daily or intense exercise 3-5 times a week)
Very Active (Heavy exercise 5 times a week)
Extra Active (Daily intense exercise or physical job)
Other
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