Exit Survey for Sessions Hi! I'm glad you're interested in my services, please complete the survey below so I can have a better idea of what you need and what issues to address. I look forward to working with you! Question Title * 1. Please enter your name Question Title * 2. And your email :) Question Title * 3. When's your birthday? Date / Time Date Question Title * 4. What are you looking for? Guidance on changing diets (Ex: vegan to omnivore) Guidance for weight loss Guidance for weight gain Help to treat constipation Help to treat diarrhea Help to treat bloating Other (please specify) Question Title * 5. What's your current stress level? 0 100 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 6. What emotion(s) do you feel the most? Anger, frustration, irritability Sadness, grief, depression Anxiety, worry Indifference Fear of failure or loss Other (please specify) Question Title * 7. Have you had any surgeries? Any organs removed? Question Title * 8. Do you have any disease or had any diseases in the past? Please explain Question Title * 9. Have you had or still have any allergies? Please specify Question Title * 10. Are you on any medication? No Yes (please specify) Question Title * 11. Describe how regular are your bowel movements, and are you satisfied with that? Question Title * 12. What do you typically eat in a day? Question Title * 13. How often do you eat? Once a day Twice a day 3 times a day 4+ times a day Question Title * 14. How much water do you drink per day? 1-2 cups 2-4 cups 1 - 1.5 L 2 L or more Question Title * 15. How often do you exercise? Daily 2-3 times a week 4-5 times a week Never/rarely Question Title * 16. How much coffee do you consume? 1 daily 2-3 daily 4+ Never/rarely Question Title * 17. Do you consume any cannabis? No Yes (please specify how often and what type) Question Title * 18. Do you consume any alcohol? No Yes (please specify how often and what type) Question Title * 19. Is white sugar a part of your diet? Whether in food or drinks... Yes, daily Yes but not every day Never/rarely Question Title * 20. How do you usually sleep? Very good, I wake up fresh I sleep enough but I wake up tired I don't sleep enough My sleep schedule is all over the place Question Title * 21. How often do you eat home-cooked meals? Every meal Once a day Never Other (please specify) Question Title * 22. How often do you eat junk food? And what type? Question Title * 23. How would you describe your personality in a few words? The good, the neutral and the bad traits, please! Question Title * 24. For women only - please describe your menstrual cycle issues, if you have any. Do you PMS? Do you have pains? Do you get acne? etc. Question Title * 25. Do you have any of these: Weak nails Weak or falling hair Acne Rashes Other (please specify) Done