What's your Wellness Score?

Does your overall wellness need a little boost? If you don't feel as good as you used to, then this free evaluation is for you!

• Your personal Wellness Evaluation Score
• Your Body Mass Index, which can help you identify your risk for disease
• The Book : "Wellness Evaluation", a free gift for you
• A FREE follow-up consultation with your personal Wellness Coach!

Your coach can assist you in making healthy lifestyle and nutritional changes. You will receive a customized eating plan along with recommendations to simplify the steps you need to take on your way to optimal wellness.

Name

Email

Mobile

Yes

Gender

Male Female

Height

Weight

Age

Under 18 18-29 30-39 40-49 50-59 60 or over

1.Do you eat more meals with poultry, lean meat, fish and plant (soy) proteins rather than steaks, roasts and other red meats?

No Yes

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

No Yes

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

No Yes

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

No Yes

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

No Yes

6.Is your digestive system free of indigestion or irregularity?

No Yes

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

No Yes

8.Do you maintain a stable and appropriate weight?

No Yes

9.Do you usually have time to prepare balanced meals, instead of buying fast food or eating on the run?

No Yes

10.Do you stay away from soda and typical snack foods throughout the day and after dinner?

No Yes

11.Do you have the energy and focus you need to meet your daily challenges?

No Yes

12.Do you drink at least 8 glasses of water a day?

No Yes

13.Are you getting your daily recommended allowance of Calcium? a. Men = 1,000mg b.Women under 50 = 1,200mg c.Women 50 and older = 1,500mg

No Yes

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

No Yes

15.Are you free from problems associated with your prostate such as slow urination or waking up at night to urinate?

No Yes

Almost finished!

Your Wellness Coach will analyze your answers then contact you about your Wellness Evaluation to recommend a personalized program to meet your health and wellness needs.