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Free Wellness Assessment
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1
Basic information
*
This field is required
Your name
Select your gender
Male
Female
Select your gender
Male
Female
To calculate your BMR
Select your age
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110
Select your age
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110
To calculate your BMR
Select your country
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
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
To prioritize commonly consumed foods
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2
Basic Information
*
This field is required
Select your weight (in lb)
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Select your weight (in lb)
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40
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450
To calculate your BMR
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"
4' 9"
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"
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"
4' 9"
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"
To calculate your BMR
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3
Body Type
*
This field is required
Ectomorph (thin, wiry build)
Mesomorph (medium, muscular build)
Endomorph (wide, heavy build)
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4
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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5
Dietary Preferences
*
This field is required
Select all food groups that are part of your regular weekly diet
Plant-based Foods
Eggs
Poultry
Red Meat
Dairy
Seafood
Mushrooms
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6
Allergies
Select all that apply
Dairy (Lactose)
Eggs
Wheat (gluten)
Peanuts
Tree Nuts
Fish
Shellfish
Soy
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7
Any known medical issues?
Hypertension
Diabetes
Asthma
Cholesterol
Allergies
Kidney Stones
Ulcers
Arthritis
Insomnia
Hairfall
Stress
Anxiety
Depression
Fatigue
Migraine
Hyperthyroidism
Hypothyroidism
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8
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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9
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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10
When your digestion is out of whack, you have a tendency towards
*
This field is required
Constipation, bloating, gas
Acidity, heartburn, diarrhoea
Excess mucus in stools, feeling of incomplete elimination
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11
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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12
You are
*
This field is required
Very active, fidgety
Purposefully active
Mostly sedentary
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13
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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14
Your friends feel that you are
*
This field is required
Moody
Passionate
Calm
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15
Digestion
*
This field is required
I have a good appetite at meal times and my digestion is great
Once in a blue moon
Every other day
On most days
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16
Sleep
*
This field is required
I sleep well and feel rested in the morning
Very rarely
Few days in a week
On most days
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17
Stamina/ Energy
*
This field is required
I feel light and energetic
Till about mid day
Till Evening
Right through the day
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18
Immune Function
*
This field is required
The last time I fell sick was
Less than a month ago
A few months ago
Can't remember the last time I fell sick
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19
Physical Health
*
This field is required
I feel aches and pains in my joints
Pretty much every day
Every once in a while, on stressful days
Only if I injure myself
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20
Mental Health
*
This field is required
The last time I felt stressed out, anxious or depressed was
Less than a month ago
A few months ago
So long back, I cant remember when
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21
Email
[email protected]
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22
Enter Your Email
*
This field is required
so that we can send you the complete report
[email protected]
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23
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