Norsk
Svenska
Step 1 of 2
Personal Health Check
Sex
Male
Female
What did you eat yeasterday and what did you have to drink?
Breakfast?
Dinner and what did you have to drink beside?
Supper
Other. Coffee?
How many times a week do you exercise more than 30 minutes?
5-7 times a week?
3-4 times a week?
1-2 times a week?
Never
Height, Weight, Age
Height (eks: 178)
Weight (eks: 85)
Age (eks: 35)
Please choose what option which is most similar to your bodytype:
The overweight is mostly on my upper body
The overweight is mostly around the waist
I a not overweight
My ideal weight would be
What would your ideal weight be?
At what age were you when you had this weight before?
Do you have any of the health issues mentioned below?
Digestion problems
Stress, nerves, bad mood, depression
Low/High metabolism
Allergies, rashes, exsema
Headache, Migrene
Tired, lack of energy
Diabetes
Heart diseases
What would you like to do?
Lose weight in a simpel, safe and efficient way
Gain weight and build muscles, and lower my fat percentage
More energy to handle everyday-life
Better food-control through a balanced intake of karbs and proteins
Less sweet cravings and gain appetite control
Prevent health issues
Bodyshaping
Improve my breakfast habits
Utilize my exercise (maximise the result with the same effort)
Other
Why?
Additional questions- Would you like to improve any of the areas/topics mentioned below?:
My Health (Through a Shapworks Program)
More Sparetime (Better life quality)
More Savings
Financial Security
Extra Income
Nothing
If Yes, Why?
If Yes, Why? Any particular reason?
Contact details:
Your name:
Post code
Post code
Postal adress
email
Mobile
Phone
Please complete your personal health check and see your result
Personbeskyttelse
|
Copyright & Disclaimer
|
Kontaktinformation
|
