Lifestyle Questionnaire

    Typical Day

    Please Rate the Following

    How do you sleep?
    1 - Poor2345678910 - Perfect

    How is your digestion?
    1 - Poor2345678910 - Perfect

    How is your elimination?
    1 - Poor2345678910 - Perfect

    Rate your stress level
    1 - Poor2345678910 - Perfect (no stress)

    Rate your happiness level
    1 - Poor2345678910 - Perfect

    Rate your health level
    1 - Poor2345678910 - Perfect

    Satisfaction




    Final Questions

    Do you meditate?

    Do you have a yoga practice?

    Do you exercise?

    Do you drink caffeine ?

    Do you use tobacco?