Assessment – Personal – Vitality Through Motion

Your responses will allow us to craft a consultation that meets your unique needs, so we can provide the most relevant, life-enhancing guidance for your health and vitality. Don’t let your future be hindered by preventable challenges; let us help you protect what truly matters.

How many hours per week do you work in an office setting?

How many hours per week do you work from home?

How many hours per week do you commute?

Do you have air travel for work?

Yes No

If yes, how many times per month? (If No, mark 0)

What are the average lengths of flights (hours)?

What exercise(s) do you do? What is the time and frequency of each?

What body-care or cross-training do you do? (stretching, massage, etc)

What sports do you participate in, and how often?

How many children do you have?

How many living at home?

What are their ages?

What percentage of your meals per week do you prepare yourself?

Do you take herbs or vitamin supplements?

Yes No

If yes, which are Most common or consistent? How often?

Have you ever done a nutritional cleanse or detox?

Yes No

Full Name

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