Assessment

Your FREE HEALTH AND ENERGY ASSESSMENT

Your Assessment Form

How healthy and energetic do you feel?

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Health Assessment

Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


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Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


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Total Score:
Ideal target: 14 or less

Energy & Blood Sugar Control:

Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


Disagree........................Agree


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Disagree........................Agree


Total Score:
Ideal target: 16 or less

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if your score is for over 26 on either scale, there is room for serious improvement!

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Health and Energy Assessment
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(000) 000-0000

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M-F: 11am - 7pm

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Sun: 10am - 5pm

Health and Energy Assessment
Visit Us

Your Address (Optional)

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Contact us

(000) 000-0000

[email protected]

[email protected]

Open Hours

M-F: 11am - 7pm

Sat: 10am - 7pm

Sun: 10am - 5pm

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