First Name
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Last Name
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Phone
Email
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I eat whole foods and avoid processed, junk, fast foods even when I eat out.
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Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I eat an 80%+ nutrient-rich diet, with at least 5 servings of vegetables and fruits daily.
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Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I get good, sustaninable energy from what I eat and feel vibrant throughout the day.
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Never Me
Seldom Me
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Often Me
Always Me
I am rarely bothered by what I eat and don't have food sensitivities.
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Always Bothers Me
Often Bothers Me
Sometimes Bothers Me
Seldom Bothers Me
Never Bothers Me
I avoid soda, energy or other commercially processed sugary, diet drinks or beverages.
Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I occasionally use stimulants such as caffeine but avoid excessive consumption.
Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I am free from alcohol drugs, nicotine, and medication dependency.
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Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I take nutritional supplements regularly (e.g.. vitamins, minerals, antioxidants and omegas.)
Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I regularly consume additional greens as part of a daily supplement or smoothie routine.
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Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
Regardless of what I eat I rarely experience heartburn, indigestion, gas or bloating.
Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I regularly supplement with fiber, enzymes and probiotic products.
Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
I rarely suffer from bad breath.
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Never Me
Seldom Me
Sometimes Me
Often Me
Always Me
If I have children they take nutritional supplements/vitamins regularly.
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Never Me
Seldom Me
Sometimes Me
Often Me
Always Me