Health & Wellness Consultation Questionnaire

1

NameTell me who you are 💚

First Name

Last Name

2

Gender

Male

Female

3

AgeHow young are you?

years

4

What do you do for a living?Tell me a little about yourself!

5

Are you on any medications or under a doctors care?If yes, please consult with your doctor before adding any new supplements to your routine.

6

What’s your biggest challenge?

Feeling tired and low on energy

Struggling to focus and stay organized

Managing pain and discomfort

Staying calm and reducing stress

Balancing weight and maintaining a healthy diet

Other

7

How would you describe your energy levels throughout the day?

I feel tired most of the time.

I start strong but fade quickly

I’m usually sluggish and need a pick-me-up in the afternoon.

My energy is low, especially after meals.

I have moments of energy, but they are rare.

I am the energizer bunny! My energy levels are high.

Other

9

How active are you?(On a normal daily basis)

I'm too tired to exercise regularly.

I want to be more active but pain gets in the way.

I'm active, but I struggle with post-excercise pain or inflammation.

I try to exercise but my energy doesn't last.

I want to start working out, but I don't have the energy.

I don't exercise.

Other

10

What’s your main goal in improving your health?

Boosting energy to keep up with my daily demands.

Reducing inflammation so I can be more active.

Getting relief from bloating and digestive issues.

Finding the motivation to workout and feel strong.

All-around improvement in energy, fitness, and well-being.

Other

11

How often do you experience discomfort due to pain or inflammation?

Rarely, but I do feel tired.

Occasionally, especially after physical activity

Frequently, it affects my daily routine.

It's a constant struggle.

Every day, and it impacts my energy and mood.

Other

12

What’s most important to you when choosing a health supplement?

It needs to give me a noticeable energy boost.

It should help reduce my pain and inflammation.

I want something that helps with bloating and digestion.

I need a combination of energy and pain relief.

It should improve my overall well-being.

Other

13

What’s your ideal outcome from using Bravenly products?

Feeling energized and focused throughout the day.

Achieving and maintaining a healthy weight

Improving strength, endurance, and recovery

Living pain free and staying active

Enhancing overall health and well-being

Other

14

What’s your biggest health challenge?

Staying alert and focused throughout the day.

Losing weight and keeping it off.

Enhancing physical performance and recovery.

Dealing with chronic pain and inflammation.

Maintaining a healthy, balanced lifestyle.

Other

15

How would you describe your current diet?

Balanced, but I feel low on energy.

High in carbs, and I often feel sluggish.

Low-carb or keto, but I struggle with cravings.

Healthy, but I experience bloating and digestive issues.

I try to eat well, but I need more consistency.

Take out King or Queen

Other

16

How often do you experience cravings for unhealthy foods?

Rarely, I usually feel in control.

Occasionally, especially when I'm tired or stressed.

Often, particularly for carbs and sweets.

Frequently, especially when I feel bloated or uncomfortable.

Almost daily, it's hard to resist.

17

How often do you experience mood swings, irritability, or other symptoms related to hormonal imbalances?

Rarely, I feel balanced most of the time.

Occasionally, especially during certain times of the month.

Frequently, it's a regular struggle for me.

Almost daily. It affects my energy and well-being.

I'm not sure, but I often feel "off" and can't pinpoint why.

Other

18

How often do you find it difficult to concentrate or stay focused on tasks?

Rarely, I'm usually able to stay on task.

Occasionally, especially when I'm tired and stressed.

Frequently, I struggle to maintain focus throughout the day.

Almost daily, it's a major challenge for me.

I find it hard to focus on anything, even simple tasks.

Other

19

If you could only choose one thing to improve your health right now, what would it be?

Boost my energy levels.

Reduce my pain and inflammation.

Improve my focus and mental clarity.

Manage my weight effectively

Find relief my bloating and digestive issues.

Relieve muscle soreness & fatigue

Other

20

What is your main interest today?

I am interested in improving my health

I am interested in learning about Bravenly's naturopathic supplements

I am interested in learning how to purchase Bravenly products with a discount

I am interested in sharing a link and getting a little jingle in my pocket

I am interested in building a business with Bravenly

Other

21

Phone Number

Please enter a valid phone number.

22

Email

example@example.com

23

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