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questions
Section 1
Do you class yourself as stressed?
*
Yes
No
Do you have any trouble getting to sleep?
*
Yes
No
Do you wake up during the night?
*
Yes
No
In the past 24 months, have you experienced any of the following? - death of a loved one, partnership or marriage breakdown, infertility, severe illness, moving cities?
*
Yes
No
Do you suffer from fatigue?
*
Yes
No
Do you consume more than 2 cups a coffee a day?
*
Yes
No
Do you sweat easily?
*
Yes
No
Do you suffer from anxiety or mood swings?
*
Yes
No
Section 2
Do you drink alcohol in excess of 2 drinks a week?
*
Yes
No
Do you consume canned or packaged food?
*
Yes
No
Would you consume foods with added sugar more than once per week?
*
Yes
No
Do you eat 'treat' foods, like cookies, cakes or chips?
*
Yes
No
Do you use margarine or butter?
*
Margarine
Butter
Do you eat low fat flavoured yoghurts?
*
Yes
No
Do you consume wheat pasta, white bread or white rice?
*
Yes
No
Do you drink any soft drinks?
*
Yes
No
Section 3
Do you eat 6 or more serves of vegetables every day?
*
Yes
No
Do you eat a large serve of dark green leafy veggies each day?
*
Yes
No
Do you consume oily fish, chia seeds, flaxseeds or walnuts?
*
Yes
No
Do you eat nuts and seeds every day?
*
Yes
No
Do you eat 2 or more serves of fresh fruit each day?
*
Yes
No
Do you inlcude avocados, cold pressed olive oil, coconut oil or macdamia oil in your diet?
*
Yes
No
Do you suffer from bloating or wind?
*
Yes
No
Do you suffer from reflux or burping?
*
Yes
No
Section 4
Do you use a plastic water bottle or plastic food storage containers?
*
Yes
No
Do you eat food from cans more than once per week?
*
Yes
No
Do you use conventional soaps, detergents, shower items or personal care products?
*
Yes
No
Do you eat over 50% of your diet from organic foods?
*
Yes
No
Do you have a poor tolerance of alcohol or feel queezy or yukky after a fatty meals?
*
Yes
No
Do you eat non-organic eggs, chicken, pork, beef or dairy?
*
Yes
No
Do you work with or live around solvents, paints, dyes, air fresheners, smokers or fumes?
*
Yes
No
Do you suffer from hormonal problems, headaches or migraines?
*
Yes
No
Section 5
Do you exercise regularly?
*
Yes
No
Do you exercise less than 3 times per week?
*
Yes
No
Do you break out a sweat more than twice a week?
*
Yes
No
Do you work in a sit down job?
*
Yes
No
Do you watch more than 30 minutes of TV a day?
*
Yes
No
Do you suffer from back, neck or shoulder pain that is not injury related?
*
Yes
No
Do stretch your body for at least 5 minutes less than twice a week?
*
Yes
No
Are you spending less than 2 hours on your feet each day?
*
Yes
No
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