MyLAZY-HEALTHY™ Custom

What is your name?

What is your email address?

What is your age?

What is your primary health goal?

Weight loss

Muscle gain

Better energy

Overall wellness

How would you describe your current activity level?

Sedentary (little to no exercise)

Lightly active (1-3 days/week)

Moderately active (3-5 days/week)

Very active (6-7 days/week)

How many hours of sleep do you get per night?

Do you have any dietary restrictions?

None

Vegetarian

Vegan

Gluten-free

How many meals do you typically eat per day?

How much water do you drink daily?

Less than 4 glasses

4-6 glasses

7-8 glasses

More than 8 glasses

Do you take any supplements currently?

What is your stress level on a typical day?

Low

Moderate

High

Do you have any existing health conditions?

How often do you experience digestive issues?

Never

Occasionally

Frequently

What time of day do you feel most energetic?

Morning

Afternoon

Evening

How would you rate your current diet quality?

Poor

Fair

Good

Excellent

What is your preferred type of exercise?

How much time can you dedicate to exercise per week?

Less than 1 hour

1-3 hours

3-5 hours

More than 5 hours

Do you have any food allergies?

What motivates you most to improve your health?

Looking better

Feeling better

Preventing disease

Living longer

Is there anything else you'd like us to know?

Thank you!

Your responses have been submitted. We'll create your personalized health plan and contact you within 3 business days

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