WELLNESS EVALUATION
The first step towards the best version of yourself.
Your name and surname
Age
Phone Number
Please enter a valid phone number.
Which Messaging App do you prefer
WhatsApp
Telegram
Facebook Messenger
Other
Your best email address
example@example.com
Social Media
Facebook
Instagram
Other
Back
Next
Your Lifestyle
What do you usually do
Define your goals
What are your goals?
1 - Body Weight
I want to lose weight
I want to increase weight
I want to manage my weight
Other
How much weight do you want to lose?
2 - I want to (Choose one or more options)
Lose centimeters
Drop a dress size
Be more muscular
Be more toned
have better energy and vitality
Other
3. If you have other objectives please describe below:
How determined are you to reach your goal?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
Back
Next
What do you have for breakfast
Answer what you typically have
What time do you wakeup?
What time do you usually have breakfast?
Where do you have breakfast?
At home
Not at home
Dipends...
Describe briefly what you usually eat and drink for breakfast
How do you feel after breakfast? (please choose one or more options)
Good
Bloated
Feeling heavy
Stomach burn
Sleepy
Still hungry
Other
How much do you usually spend on breakfast?
Less than 1 euro
1-2 euro
2-3 euro
more than 3 euro
Back
Next
Your morning
What do you usually do
Do you eat or drink anything is the morning?
Yes
No
Sometimes...
How many time during the week?
1-2 times
2-3 times
more than 3 times
Describe briefly what do you eat and drink in the morning
How do you feel after your morning snack? (please choose one or more options)
Good
Bloated
Feeling heavy
Stomach burn
Sleepy
Still hungry
Other
How much do you usually spend on your morning snack?
Less than 1 euro
1-2 euro
2-3 euro
more than 3 euro
Back
Next
Your Dinner
What do you usually do
Where do you usually have dinner?
Home
Not at home
Dipends...
Do not have dinner
What time do you usually have dinner?
Describe briefly what do you eat and drink for dinner
How do you feel after your morning snack? (please choose one or more options)
Good
Bloated
Feeling heavy
Stomach burn
Sleepy
Still hungry
Other
How much do you usually spend on your dinner?
1-3 euro
3-6 euro
6-9 euro
more than 9 euro
Back
Next
Your Afternoon
What do you usually do
Do you eat or drink something in the afternoon?
Yes
No
Sometimes...
How many times during the week?
1-2
2-3
more than 3
Describe briefly what do you eat and drink in the afternoon
How do you feel after your afternoon snack? (please choose one or more options)
Good
Bloated
Feeling heavy
Stomach burn
Sleepy
Still hungry
Other
How much do you usually spend on your afternoon snack?
Less than 1 euro
1-2 euro
2-3 euro
more than 3 euro
Back
Next
Your Supper
What do you usually do
Where do you usually have dinner?
Home
Not at home
Dipends...
Do not have dinner
What time do you usually have supper?
Describe briefly what do you eat and drink for supper
How do you feel after supper? (please choose one or more options)
Good
Bloated
Feeling heavy
Stomach burn
Sleepy
Still hungry
Other
How much do you usually spend on your dinner?
1-3 euro
3-6 euro
6-9 euro
more than 9 euro
Back
Next
Your Evening
What do you usually do
Your Afternoon
What do you usually do
Do you eat or drink something in the afternoon?
Yes
No
Sometimes...
How many times during the week?
1-2
2-3
more than 3
Describe briefly what do you eat and drink in the afternoon
How do you feel after your afternoon snack? (please choose one or more options)
Good
Bloated
Feeling heavy
Stomach burn
Sleepy
Still hungry
Other
How much do you usually spend on your afternoon snack?
Less than 1 euro
1-2 euro
2-3 euro
more than 3 euro
Do you eat or drink something in the evening?
Yes
No
Sometimes...
How many times during the week?
1-2
2-3
more than 3
Describe briefly what do you eat and drink in the evening
Back
Next
Your Lifestyle
What do you usually do
How many litres of water do you drink in a day?
Less than 1 litre
1 litre
1.5 litres
2 litres
more than 2 litres
How many cups of coffee do you usually have each day ?
I do not drink coffee
1-3
3-5
more than 5
Do you use any medications?
Yes
No
Do you have any food intollerances?
Yes
No
Do you regularly go to the bathroom?
Regularly
Not regularly
Do you feel hungry during the day?
Yes
No
What time do you feel hungry?
During the morning
In the afternoon
In the evening
Other
Do you regularly do any physical exercise ?
Yes
No
Do you feel exhausted during the day ?
Yes
No
Back
Next
What type of work
We spend most of our day at work. The type of work we do affects how we feel.
What is your occupation?
Are you happy with your job environment?
Yes
No
What do you like about your job? (Choose one or more options)
Pay my bills
Good future prospect
Personal growth and satisfaction
The work environment
The work hours
Love my job
I have a mission
Other
In the future do you think that your job will garantee a good lifestyle for you and your family?
Yes
No
I do not know ...
Are you looking for another opportunity that will help you have a good lifestyle for you and your family?
Yes
No
Back
Next
Calculate
What is your weight in kg
example 80.5
Your height in cm
Example 1.76
Recommended Daily Water Intake in Litres
Basal Metabolic Rate (BMR) in Calories
BMI Weight Status Below 18.5 Underweight 18.5—24.9 Healthy 25.0—29.9 Overweight 30.0 and Above Obese
Basal Metabolic Index (BMI)
BMI Weight Status Below 18.5 Underweight 18.5—24.9 Healthy 25.0—29.9 Overweight 30.0 and Above Obese
Recommended Healthy Body Weight in kg
BMI Weight Status Below 18.5 Underweight 18.5—24.9 Healthy 25.0—29.9 Overweight 30.0 and Above Obese
Recommended Daily Protein Intake in gramms
BMI Weight Status Below 18.5 Underweight 18.5—24.9 Healthy 25.0—29.9 Overweight 30.0 and Above Obese
Submit
Should be Empty: