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The Mini - Vital Health Assessment.


This questionnaire about your lifestyle habits helps me learn more about your overall health and shape our future conversations. It's from your answers here that I'll build your personalized program — so feel free to share as much detail as possible! Your answers are confidential and will never be shared with a third party. Duration: about 10-15 minutes.

Amount
€90
What is your family/relationship status?
Married/living with partner, no children
Married/living with partner, with child(ren)
Single, no children
Single, with child(ren)
What is your blood pressure generally like?
Low blood pressure
High blood pressure
Normal blood pressure
Not sure
Were you born by C-section? Were you breastfed?
Born by C-section, breastfed
Born by C-section, formula-fed
Born by C-section, unsure if breastfed
Not born by C-section, breastfed
Not born by C-section, formula-fed
Not born by C-section, unsure if breastfed
Unsure about both questions
For women not using hormonal contraception, your periods are:
For women not using hormonal contraception: how long are your cycles generally?
Fewer than 25 days
Between 25 and 35 days
More than 35 days
Do you have dental amalgams? (fillings, metal crowns)
Yes
No
Regarding temperature, are you...?
Tend to feel cold
Heat-intolerant / sweat easily
Tolerate both heat and cold well
Do you have joint, back, or neck pain?
Sometimes
Often
Never
Do you smoke?
Yes, regularly
Yes, occasionally
Former smoker
No
Do you get frequent ENT infections (nose, throat, ears)?
yes
No
Do you have eczema or psoriasis?
Yes, psoriasis
Yes, eczema
Yes, both
No
Do you get frequent urinary tract infections?
Yes
No
Do you have acne?
Rarely
Moderately
Significantly
No
Do you get anxious or stressed easily?
Rarely
Moderately
Significantly
No
Do you often feel bloated, gassy, or burp frequently?
Never
Moderately
Significantly
No
Do you feel a sudden energy crash or heaviness after meals?
Sometimes
Often
Rarely/Never
Do you feel tired when you wake up?
Sometimes
Often
Rarely/Never
Do you feel low or unmotivated?
Sometimes
Often
Rarely/Never
Do you experience cravings or compulsions (snacking, chocolate, alcohol...)?
Sometimes
Often
Rarely/Never
Do you feel easily irritable or impatient?
Sometimes
Often
Rarely/Never
Which taste do you gravitate toward?
Do you drink alcohol?
One drink a day
More than one drink a day
Occasionally
Never
How many servings of fruits and vegetables do you eat per day (one serving ≈ 80-100g)?
Fewer than 2 servings a day
Between 2 and 4 servings a day
More than 4 servings a day
What sweeteners do you use most often?
What kind of fats do you consume daily?
What cooking methods do you use most often?
Are you...?
Vegetarian
Vegan
Pescatarian
Omnivore/Flexitarian
Do you eat red meat more than twice a week?
Yes
No
Do you make sure to include a protein source in each meal?
Yes
No, not every meal
Do you consume cow's dairy (cheese, milk, yogurt, cream...)?
1 to several times a day
2 to 5 times a week
Never
Occasionally
Do you eat oily fish (sardine, mackerel, salmon, herring, tuna, anchovy)?
1-2 times a week
2 or more times a week
Never
Occasionally
Do you drink coffee, tea, or caffeinated beverages?
Once a day
1 to 3 times a day
3 times a day or more
Occasionally or never
Do you eat starches (bread, pasta, rice, potatoes...)?
Once a day
1 to 3 times a day
3 times a day or more
Occasionally or never

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