Wellness Survey

  • Wellness Survey

  • Welcome to our wellness survey, we estimate that it will take you around 5 minutes to complete. Our survey covers the following aspects of your health and well being:
  • Eating Habits
  • Drinking Habits
  • Appetite and Energy Levels
  • Personal Wellbeing

  • Personal Details

  • What type of eater are you? (Tick those applicable to you!)

  • Eating Habits

  • What do you eat for...
  • What types of Take Away do you eat?
  • How many times per week do you eat Take Away Meals? (Breakfast, Lunch and/or Dinner)

  • Drinking Habits

  • How do you have your Tea?
  • How do you have your coffee?
  • What other drinks do you consume at least weekly?
  • What types of Alcohol do you drink?

  • Apetite and Energy Levels

  • When are you most hungry?
  • What is your general daily energy level?
  • When are you most tired?

  • Personal Wellbeing

  • Do you exercise?
  • What types of exercise do you do, at least weekly?

  • Thanks for taking the time to answer these questions, this will help you create a healthier lifetyle, please select a date and what times suits you for our next appointment (e.g. Date and Times Available 6:30pm to 9pm)

  • Appointment
  • Reload
  • Should be Empty: