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Health & Wellness Questionnaire

Hey there,

Thank you for taking the time to fill in this questionnaire. We’re looking forward to seeing your responses.

As a thank you I will email you a free PDF on 4 key areas to Make a Healthy Active Lifestyle YOUR new normal. This is not automated so please allow up to 48 hours to receive your email.

And of course you are invited to come join us for lunch at our Smoothie Club – let me know if you’d like an invite.

Yours in health







    YesNoWhat is Visceral fat?


    Not important at all Extremely important

    Not committed at all Extremely committed

    I want to LOSE body fatI want to GAIN lean muscleI want to IMPROVE my energy levelsI want to have more QUALITY sleepI want to REDUCE my health risks (e.g. heart disease, diabetes, stroke, some cancers, osteoporosis)I want to IMPROVE my ImmunityI want a SIMPLE strategy to achieve my health & wellness goals

    4 Week Fit Challenge (Lower Hutt)7 Day Eat Clean & Smoothie Challenge (Online)I'd love an invite to sample the skin care range (free - Lower Hutt)Give me access to a 17 minute video - info on the nutrition range and results people are gettingNutrition Support Products and Programs (Personalized to you - worldwide)How to optimise your health & wellness and earn an additional $500 - $1,000 per month part timeHow to optimise your health & wellness and earn an additional $1,500 - $2,500+ per month