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Your Lifestyle Questionnaire

Page 1

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Question 1.

What would be your 90day health goal and your lifelong health goal?

- Required.
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Question 2.

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

- Required.
This is required
This is required
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Question 3.

What would be your biggest health concern in the future?

- Required.
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Question 4.

Do you have Health Insurance or Medical Aid?

- Required.
This is required
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Question 5.

How much do you spend on Vitamins / Supplements weekly?

- Required.
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Question 6.

Are you trying to eat healthier?

- Required.
This is required
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What do you eat the most in your household?

- Required.
This is required
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Question 7.

Do you enjoy preparing and cooking meals?

- Required.
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Question 8.

List in order your most frequent cooking style?

- Required.
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Question 9.

How important is eliminating the following from your meals?

- Required.
Oils
Fats
Greases
Salts
Sugars
Processed Spices with animal products
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Question 10.

This is a 15mins Zoom or Teams Meeting to know you better. Do you have any of the two Apps?

- Required.
This is required
This is required
Question 11.

We want to help as many people as we can. If we help you, will you refer us to your friends and family?
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Question 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.

- Required.
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Question 13.

Your contact details:

- Required.