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Step 1: 5-Day Free Trial Questionairre

How did you hear about the 5-Day Free Trial?
Facebook
Instagram
Friend/Family
What are your current health goals?
Weight Loss
Lifestyle Change
Improve Blood Pressure
Improve Reproductive Health
Improve Relationship with Food
Improve Energy Levels
Improve Attention/Focus
What diet/nutrition programs or eating styles have you tried in the past? Did they work for you? Why/Why not?
Vegan Diet
Paleo Diet
Atkins
Weight Watchers
Low Carb
South Beach
Jenny Craig
Pre-Packaged Food
21-Day Fix
Other
What is your biggest struggle you face when changing your nutrition? *Here are some examples! Ex. Limited time, cravings, hunger, social outings.
How many times a week do you eat out?
1-3
4-6
7+
How many times a week do you cook?
1-3
4-6
7+
What are your most frequent restaurants (fast food and dining)?
What are your favorite snacks (healthy and not so healthy)?
Are you a sweet or salty person?
Sweet
Salty
Both
24 hour diet recall: Tell me what you have eaten in the past 24 hours.
Do you feel you would be more successful with your health and fitness goal if you had an accountability partner?
Yes
No
Unsure
What approach to a Nutrition Program best fits you? How do you see yourself having the most success?
Group Approach: Online Group (Facebook Group!)
Personal Approach: One on One (Online Video Conference)
Single Approach: DIY (Do It Yourself)
Friend Approach: DIY w/ a friend or partner!
Type your name and email address!
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