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OK! Its time for a heart to heart on your health!

Fill out the assessment below and receive a FREE 30 min discovery call.

We all know, its easier to reach your health goals, when you know whats holding you back and you have help to get you where you want to be.

Please take a moment to answer the questions below, so I can better understand you and together we can create the health of your dreams! Symentha xo

Take the Health Assessment below

Name *

First

Last

DOB. *

Relationship status

What line of work are you in?

Main areas of concern. *

Unhealed Childhood Trauma?

How are your stress levels?

Currently going to the gym or exercising?

How is your elimination?

*bloating, constipation, diarrhea?

Do you take any supplements?

Any medications?

Any medical issues?

Last time you had a physical?

What is your body type?

Gain weight easily
Thin and lean
Lose weight easily

Family Medical History

Pets?

How much water do you drink per day (average?) *

Less then 8 glasses
8 glasses
More then 8 glasses

Do you drink. *

Mostly Water
Pop
Coffee
Tea
Juice
Alcohol

How much sugar do you consume per day? *

*Breads, carbs, alcohol?

How is your sleep?

What are your food cravings when you are under stress? (Whats your comfort food of choice?)

Do you eat after 7PM? If so what do you eat?

Do you know your blood type?

Additional comments or notes.

Email *

Comment

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