Thank you for participating in the Eating for Health™ Course Enrollment Assessment.
Upon successful completion of the survey, you will be granted access to the Eating for Health™ course. If you opt to share your name and email, we'll include you in our mailing list and send you the course link. This way, you can revisit the material at any time and stay updated on relevant information and future offerings. Your privacy is important to us, and your information will be handled confidentially.
Your privacy is important to us. We want to assure you that we do not share your names or email addresses with any third parties. Your information is kept confidential and is solely used for communication purposes related to our services and to improve the delivery of our services to the world.

Question Title

* 1. First and Last Name

Question Title

* 2. Email

Question Title

* 3. Which of the following do you think best describes you?

Question Title

* 4. Age

Part 1 - Current Lifestyle and health goals

Question Title

* 5. How would you describe your current eating habits?

Question Title

* 6. On a scale of 1-10, how satisfied are you with your current level of well-being?

Where 1 represents very unhealthy lifestyle habits, and 10 represents very healthy lifestyle habits.

Select a number on the scale that best reflects your current habits.

1 I feel I have a balanced mix of lifestyle habits 10
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 7. What are your three primary health and wellness goals right now?

Question Title

* 8. Do you have any specific Health Concerns and/or conditions you'd like to address?

Part 2 - Dietary Preferences

Rate yourself from 1 to 5 on the following: (1 – never; 2 - occasionally; 3 - sometimes; 4 - often; 5 – always)

Question Title

* 9. Eating for Health

  1 2 3 4 5
Eat as much organic food as you can afford
Eat as much seasonal, local food as you can find
Purchase and prepare the food you eat
Avoid sugar or artificially sweetened beverages
Read labels and ask about food ingredients when eating out
Pay attention to the quality and quantity of the food
Part 3 - SAD assessment

SAD (Standard American Diet) is characterized by high processed foods, sugary drinks, and low nutrient density. Examples include fast food, soda, and excessive refined carbohydrates.

Question Title

* 10. On a scale of 1-10, how closely does your current diet resemble the Standard American Diet (SAD)?

1 10
Clear
i We adjusted the number you entered based on the slider’s scale.
Expectations

Question Title

* 11. What do you hope to gain from the Eating for Health™ course?

Question Title

* 12. Which of the following courses interests you?

Question Title

* 13. How did you hear about the Eating for Health™ course?

Question Title

* 14. Do you have any additional comments or questions?

T