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“I HOPE ALL IS WELL WITH YOU AND
THAT YOU ARE AS HEALTHY IN BODY
AS YOU ARE STRONG IN SPIRIT.”

3 John 1-2

    Name:

    Email:

    I WANT TO GET TO KNOW YOUR HEALTH HABITS

    1. Which age group do you belong to?

    2. What is your gender?

    3. Are you concerned with your health / wellbeing on a regular basis e.g. using the internet to search for health / medical information, reading the health section in newspapers / magazines, taking vitamins and supplements etc?

    YesNo

    4. Are you taking any supplements regularly?

    YesNo

    5. Are you a member of a gym / fitness program OR do you exercise regularly?

    YesNo

    6. Are you currently on any prescription medication?

    YesNo

    7. How many times on average do you visit your GP Doctor per year?

    8. How many hours of sleep do you get per day (on average)?

    9. On a scale of 1 to 5 how do you rate your overall health? 1 = Poor, 5 = Excellent

    10. What are the main reasons that you visit your GP Doctor? (tick all that apply)

    Meet Your Coach

    Kristy David

     

    I’m Kristy David and I’m an A.F.P.A certified Nutrition and Wellness Consultant. My passion is to work with people and help them reach their health goals through nutrient dense foods, proper calorie intake, portion size knowledge and control, and daily physical activity.

    I’m a wife and Mom of two sweet boys. Some of my hobbies include exercising, reading, date nights and weekend getaways with my hubby, vacationing at the beach and relaxing at the pool during the summer with my family & friends!

    I’m so excited to be part of your Health and Wellness journey!