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1
Digestion
*
This field is required.
I have a good appetite at meal times and my digestion is great
On most days
On some days
Rarely
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2
Sleep
*
This field is required.
I wake up feeling fresh and rested
On most days
On some days
Rarely
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3
Stamina/ Energy
*
This field is required.
I feel active and energetic right through the day
On most days
On some days
Rarely
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4
Immune Function
*
This field is required.
I fall sick (I visit a doctor)
Rarely (once a year)
Occasionally (once in 3 months)
Often (every month)
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5
Physical Health
*
This field is required.
My physical fitness, strength, and flexibility is
Good
Average
Poor
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6
Mental Wellbeing
*
This field is required.
I feel calm, relaxed, and in good spirits
Most of the time
Sometimes
Rarely
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7
Your skin is?
*
This field is required.
Dry, rough; Sensitive to cold; Cold to touch
Dry and oily in patches; Sensitive to heat, light and chemicals; Warm to touch
Supple and oily; Cool to touch
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8
In terms of appetite, you feel
*
This field is required.
Mildly hungry often; Full quickly; Mild discomfort when you skip a meal
Strong hunger pangs at regular meal times; Irritated if a meal is skipped; Strong thirst
A slow, consistent build up of hunger; almost no discomfort when you skip a meal
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9
Out of these which one do you experience more often?
*
This field is required.
Constipation, bloating, gas
Acidity, heartburn, diarrhoea
Excess mucus in stools, feeling of incomplete elimination
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10
Your sleep is
*
This field is required.
Light; easily interrupted; 5-6 hours sufficient
Uninterrupted; 6-7 hours sufficient
Sound and prolonged sleep; 7-8 hours required
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11
You are
*
This field is required.
Very active, fidgety
Purposefully active
Mostly sedentary
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12
As per your friends and colleagues, you are someone who can
*
This field is required.
Quickly come up with lots of ideas and think out-of-the-box
Find the fastest solution to tricky problems
Easily connect the dots and understand the big-picture
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13
Your friends feel that you are
*
This field is required.
Moody
Passionate
Calm
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14
Age and Gender
*
This field is required.
Select your gender
Male
Female
Select your gender
Select your gender
Male
Female
Select your age
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15
Weight and Height
*
This field is required.
Select your weight(in lb)
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Select your height (in feet)
3' 0"
3' 1"
3' 2"
3' 3"
3' 4"
3' 5"
3' 6"
3' 7"
3' 8"
3' 9"
3' 10"
4' 0"
4' 1"
4' 2"
4' 3"
4' 4"
4' 5"
4' 6"
4' 7"
4' 8"
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4' 10"
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5' 6"
5' 7"
5' 8"
5' 9"
5' 10"
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6' 4"
6' 5"
6' 6"
6' 7"
6' 8"
6' 9"
6' 10"
7' 0"
7' 1"
7' 2"
7' 3"
7' 4"
7' 5"
7' 6"
7' 7"
7' 8"
7' 9"
7' 10"
8' 0"
3' 0"
3' 1"
3' 2"
3' 3"
3' 4"
3' 5"
3' 6"
3' 7"
3' 8"
3' 9"
3' 10"
4' 0"
4' 1"
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4' 5"
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4' 8"
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4' 10"
5' 0"
5' 1"
5' 2"
5' 3"
5' 4"
5' 5"
5' 6"
5' 7"
5' 8"
5' 9"
5' 10"
6' 0"
6' 1"
6' 2"
6' 3"
6' 4"
6' 5"
6' 6"
6' 7"
6' 8"
6' 9"
6' 10"
7' 0"
7' 1"
7' 2"
7' 3"
7' 4"
7' 5"
7' 6"
7' 7"
7' 8"
7' 9"
7' 10"
8' 0"
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16
Body Type
*
This field is required.
Thin, wiry build (Ectomorph)
Medium, muscular build (Mesomorph)
Wide, heavy build (Endomorph)
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17
Activity Level
*
This field is required.
Sedentary (Little to no exercise, desk job)
Lightly Active (light exercise, sports 1-3 days per week)
Moderately Active (moderate exercise, sports 6-7 days a week)
Very Active (hard exercise every day, or exercising 2 times a day)
Extra Active (hard exercise 2 or more times per day, or training for marathon or triathlon, etc.)
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18
Dietary Preferences
*
This field is required.
Select all that you eat as part of your regular weekly diet
Plant-based Foods
Eggs
Poultry
Red Meat
Dairy
Seafood
Mushrooms
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19
Food Allergies
Select all that apply
Dairy (Lactose)
Eggs
Wheat (gluten)
Peanuts
Tree Nuts (Almonds, Cashews, Walnuts)
Fish
Shellfish
Soy
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20
Any known medical issues? Are you taking medication?
Hypertension
Diabetes
Asthma
Cholesterol
Allergies
Kidney Stones
Ulcers
Arthritis
Insomnia
Hairfall
Stress
Anxiety
Depression
Fatigue
Migraine
Hyperthyroidism
Hypothyroidism
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21
Name and Email
*
This field is required.
You can use your email to access your report and data anytime
Your Name
United States
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Congo {Democratic Rep}
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland {Republic}
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar, {Burma}
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
United States
United States
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Congo {Democratic Rep}
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland {Republic}
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar, {Burma}
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Your Email
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22
Email
[email protected]
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23
Phone Number (optional)
Get your Personalised Report on this number via SMS
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24
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