Your Lifestyle Questionnaire

 

1. If you had a 90day health goal, what would it be? *

 

2. Please tick any of the following diet related health concerns in your family / household? *

 

3. What would be your biggest health concern in the future? *

 

4. Do you have Medical Aid? *

 

5. How much do you spend on Vitamins / Supplements weekly? *

 

6. Are you trying to eat healthier? *

 

What do you eat the most in your household? *

 

7. Do you enjoy preparing and cooking meals? *

 

8. List in order your most frequent cooking style? *

GrillingFryingRoastingSteamingBoilingMicrowave
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9. How important is eliminating the following from your meals? *

VeryFairlyNot important
Oils
Fats
Greases
Salts
Sugars
Processed Spices with animal products
 

10. Our Consultation Fee is £250. Can you afford this?

 

11. Our meeting will be via Zoom. Do you have the Zoom App? *

 

12. How did you know about Simba's Foods? If you received a flyer, please write the booking code at the bottom of the flyer. *

 

13. Your contact details: *

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