FREE HEALTH CHECK

After you submit this form, our qualified nutritional therapist will review your responses and provide recommendation within next 48 hours on supplements to support your wellness journey.

This is a free basic health check that covers diet, symptoms and toxicity and should take no more than 5 mins.

Full Name *

Phone *

Email *

Which country do you live in? *

What would you like to improve? (You can choose more than 1) *

Do you eat fried food most days? *

Do you eat less than a serving of raw or fresh vegetables each day? *

Do you eat fewer than two pieces of fresh fruit a day? *

Do you often eat beans, lentils, quinoa, nuts, seeds, or whole grains? *

Do you eat smoked or barbecued food, or grilled cheese? *

Do you eat foods rich in vitamin C, such as bell peppers, broccoli, cauliflower, cabbage, watercress, lemons, oranges, kiwi, strawberries? *

Do you regularly eat foods rich in vitamin E, such as tuna, sardines, salmon, beans, peas, sesame seeds, wheat germ, sunflower seeds, vegetable oils? *

Do you regularly eat foods rich in vitamin A or beta-carotene, such as carrots, squash, pumpkin, cabbage, watercress, sweet potatoes, melon, mangoes, tomatoes, broccoli, beef liver, veal liver? *

Do you frequently suffer from infections (coughs, colds)? *

Do you find it hard to shift an infection? *

Do you have a recurrent infection (cystitis, thrush, earache, herpes, etc.)? *

Do you bruise easily? *

Have you ever suffered from cancer, heart disease, cataracts, diabetes, hypertension, infertility, AMD, measles, mental illness, gingivitis, arthritis? *

Have your parents collectively suffered from two or more of these conditions? *

Do you easily get exhausted after physical exertion? *

Does your skin take a long time to heal? *

Do you suffer from acne, dry skin, or excessive wrinkles for your age? *

Are you overweight? *

Do you work or live in a polluted city or by a busy road? *

Do you spend more than two hours in traffic each day? *

Do you spend time in a smoky atmosphere most days? *

Are you quite often exposed to strong sunlight? *

Do you consider yourself unfit? *

Do you exercise excessively? *

Have you smoked for more than five years of your life, less than five years ago? *

Do you smoke now? *

Do you smoke more than ten cigarettes a day? *

Do you have an alcoholic drink each day? *

At birth what was your gender?

Current Status *

What's your age group? *

Do you suffer from any of these? *

Please provide information about your current health status and any medications you are taking.

How did you hear about this? *

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