Wellness Survey

Wellness Survey
Welcome to our wellness survey, we estimate that it will take you around 5 minutes to complete. Our survey covers the following aspects of your health and well being:
Eating Habits
Drinking Habits
Appetite and Energy Levels
Personal Wellbeing
Personal Details
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Instagram Handle @*
What type of eater are you? (Tick those applicable to you!)*

Light EaterMedium EaterHeavy EaterSweet ToothStress EaterBinge EaterBoredom EaterNibbler

Eating Habits
What do you eat for...
Breakfast*
Lunch*
Dinner*
Snacks*
How many times per week do you eat Take Away Meals? (Breakfast, Lunch and/or Dinner)*

Rarely0-12-34-56-78+

Drinking Habits
Glasses of water daily?*
What other drinks do you consume at least weekly?*

Flavoured Waters (Mineral/Vitamin)Softdrinks (Coke, etc)Sports Drinks (Gatorade, etc)CoffeeTeaEnergy DrinksAlcohol (Beer, Wine, Liquor, etc)

Personal Details