Drip & Fit Wellness Hydration Assessment
Complete this detailed assessment to receive your personalized hydration score and insights.
Name
*
First Name
Last Name
Email
*
example@example.com
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1. How many cups or liters of plain water do you drink on a typical day?
*
< 1 liter
1โ2 liters
2โ3 liters
3+ liters
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2. How many hours do you typically sleep each night?
*
< 6 hours
6โ7 hours
7โ9 hours
9+ hours
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3. Do you have any medical conditions that might affect your hydration (e.g., kidney disease, diabetes)? If yes, please specify below.
*
No
Yes
Medical conditions:
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4. How would you rate your overall energy level throughout the day?
*
1โ3 (Low)
4โ6
7โ8
9โ10 (High)
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5. On average, how many times do you urinate during the day (excluding nighttime)?
*
1โ3 times
4โ7 times
8โ10 times
10+ times
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6. Which of the following beverages do you consume regularly (Select all that apply)?
*
Coffee/Tea
Juice
Milk
Soda
Sports Drink
Energy Drinks
Alcoholic Beverages
Other
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7. How often do you feel thirsty throughout the day?
*
Rarely
Occasionally
Often
Almost always
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8. What is the typical color of your urine?
*
Clear or very pale yellow
Light yellow
Dark yellow
Amber or darker
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9. Do you experience any of the following symptoms (Select all that apply)?
*
Dry mouth
Headaches
Fatigue
Dizziness
Muscle cramps
None of the above
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10. How often do you exercise or engage in physical activity?
*
Rarely
1-2 times per week
3-5 times per week
Daily
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11. How long is your average exercise session?
*
Less than 30 minutes
30-60 minutes
More than 60 minutes
I do not exercise
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12. Do you sweat heavily during physical activity?
*
Yes, a lot
Moderately
Very little
Not at all
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13. Do you live or work in a hot or dry environment (e.g., outdoors, heated buildings)?
*
Yes, regularly
Occasionally
Rarely
Never
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14. Do you follow a special diet (e.g., low carb, high protein, keto, vegan)?
*
Yes
No
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15. Are you currently taking any medications or supplements that may affect hydration (e.g., diuretics, laxatives)?
*
Yes
No
Not sure
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Hydration Score
Number
Calculation
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16. Based on how you feel right now, which is your most urgent concern?
Physical Exhaustion / Soreness
Nausea / Hangover symptoms
Cold/Flu/Travel fatigue
Migraines / Tension headaches
Skin/Hair/Nail health
Mental fog / General stress
Should be Empty: