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BACK
PART
1/4
Contact Information
Your First name*
Your last name
Your Email address*
Your Phone number*
Please enter a valid Number!
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
1/4
Your health Information
Date of birth
Your gender
Select your gender
Male
Female
Prefer not to say
Current height (cms)
Current weight (kgs)
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
Do you experience any of the following energy-related symptoms?
Persistent fatigue
Low energy
Daytime sleepiness
Post-exercise tiredness
Mid-afternoon energy dips
Mild dizziness when standing quickly
No issues
BACK
PART
2/4
What is your target sleep duration?
6-7 hours / night
7-8 hours / night
8-9 hours / night
More than 9 hours / night
BACK
PART
2/4
Which digestive symptoms bother you most?
Bloating
Gas and flatulence
Hard / dry stools
Abdominal pain / discomfort
Heartburn / Indigestion
Constipation
Feeling not fully emptied
BACK
PART
2/4
Which cognitive issues concern you most?
Brain fog
Difficulty concentrating /
focus issues
Memory problems
Slow processing speed
Mental fatigue
Mild cognitive decline
None
BACK
PART
2/4
How does stress primarily manifest for you?
Physical tension (neck, shoulders, jaw, muscle tightness)
Sleep disruption
Emotional reactivity
Difficulty concentrating
Digestive issues
Appetite changes
Restlessness/anxiety
BACK
PART
2/4
Which age-related concerns are most important to you?
Cognitive decline prevention
Energy / vitality maintenance
Joint / bone health
Cardiovascular health
Skin / appearance
Immune function
Metabolic health
Cellular repair / regeneration
BACK
PART
2/4
Do you experience joint-related symptoms?
No joint issues
Occasional stiffness
Morning stiffness
Joint pain
Inflammation / swelling
Reduced mobility / range of motion
Diagnosed osteoarthritis
BACK
PART
2/4
How often do you get sick (colds, flu, infections)?
Rarely (0-1 times per year)
Occasionally (2-3 times per year)
Frequently (4-6 times per year)
Very frequently (>6 times per year)
BACK
PART
2/4
How would you rate your current fatigue level?
Mild
Moderate
Severe
BACK
PART
2/4
How long does it usually take you to fall asleep?
< 20 mins
20–40 mins
> 40 mins (mind active)
BACK
PART
2/4
When did you last take any antibiotics?
Never / rarely
1-5 years ago
6-12 months ago
Within the last 3 months
BACK
PART
2/4
How would you rate your current cognitive performance?
Optimal / no concerns
Slightly below baseline
Noticeably declined
Significant concern
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
What stress management practices do you currently use?
Exercise / movement
Meditation / mindfulness
Breathing exercises
Social support
Time in nature
Journaling
Hobbies / creative activities
None
BACK
PART
2/4
What is your primary longevity goal?
Extend healthspan (quality of life, functional capacity, independence)
Prevent age-related diseases (avoid specific diseases: heart disease, diabetes, cancer)
Maintain independence (physical, cognitive, social independence)
Optimize biomarkers
General wellness optimisation
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
Do you have risk factors for bone loss?
Family history of osteoporosis
Female, post-menopausal
Limited sun exposure
Sedentary lifestyle
History of fractures
None of the above
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
When you get sick, how long does recovery typically take?
Less than 1 week
1-2 weeks
2-3 weeks
More than 3 weeks
BACK
PART
2/4
When do you experience fatigue most?
Morning/upon waking
Midday / post-lunch (energy crash after meal)
Late afternoon (3-5 PM slump)
Evening / consistent throughout day
Unpredictable pattern (no consistent timing)
BACK
PART
2/4
How does your mind feel at night?
Calm
Slightly active
Overthinking / racing
Anxious / stressed / wired
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
How would you describe your fiber intake?
Very low
Low to moderate
Moderate to high
High
BACK
PART
2/4
Do you experience any of these symptoms?
Morning grogginess
Afternoon energy crash
Evening wired feeling
Cravings for sweet / salty
Weight gain despite diet efforts
Nighttime wakefulness
None of the above
BACK
PART
2/4
Which immune-related symptoms concern you?
Frequent colds / flu
Prolonged recovery
Delayed wound healing
Frequent throat infections
Recurrent oral infections
Skin infections
None
BACK
PART
2/4
Which of the following accompany your fatigue?
Brain fog / difficulty concentrating
Muscle weakness
Lack of motivation
Sleep disturbance
Frequent infections / low immunity
Digestive issues
None of the above
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
Do you have any diagnosed inflammatory conditions?
IBS / IBD (Inflammatory Bowel Disease)
Food sensitivities (diagnosed or suspected)
Leaky gut concerns
None diagnosed
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
How would you rate your anxiety?
None / minimal
Mild
Moderate
Significant
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
2/4
Are immune concerns seasonal?
Year-round
Worse during winter
Worse during specific season
Depends on stress / activity levels
Combat Fatigue
Better sleep
Gut Health
Sharper cognition
Manage Stress
Healthy Aging & Longevity
Bone and Joint Health
Immune Support
BACK
PART
3/4
Do you experience any of the following energy-related symptoms?
Persistent fatigue
Low energy
Daytime sleepiness
Post-exercise tiredness
Mid-afternoon energy dips
Mild dizziness when standing quickly
No issues
BACK
PART
3/4
What is your target sleep duration?
6-7 hours / night
7-8 hours / night
8-9 hours / night
>9 hours / night
BACK
PART
3/4
Which digestive symptoms bother you most?
Bloating
Gas and flatulence
Hard / dry stools
Abdominal pain / discomfort
Heartburn / Indigestion
Constipation
Feeling not fully emptied
BACK
PART
3/4
Which cognitive issues concern you most?
Brain fog
Difficulty concentrating / focus issues
Memory problems
Slow processing speed
Mental fatigue
Mild cognitive decline
None
BACK
PART
3/4
How does stress primarily manifest for you?
Physical tension (neck, shoulders, jaw, muscle tightness)
Sleep disruption
Emotional reactivity
Difficulty concentrating
Digestive issues
Appetite changes
Restlessness/anxiety
BACK
PART
3/4
Which age-related concerns are most important to you?
Cognitive decline prevention
Energy / vitality maintenance
Joint / bone health
Cardiovascular health
Skin / appearance
Immune function
Metabolic health
Cellular repair / regeneration
BACK
PART
3/4
Do you experience joint-related symptoms?
No joint issues
Occasional stiffness
Morning stiffness
Joint pain
Inflammation / swelling
Reduced mobility / range of motion
Diagnosed osteoarthritis
BACK
PART
3/4
How often do you get sick (colds, flu, infections)?
Rarely (0-1 times per year)
Occasionally (2-3 times per year)
Frequently (4-6 times per year)
Very frequently (>6 times per year)
BACK
PART
3/4
How would you rate your current fatigue level?
Mild
Moderate
Severe
BACK
PART
3/4
How long does it usually take you to fall asleep?
<20 mins
20–40 mins
>40 mins (mind active)
BACK
PART
3/4
Have you taken antibiotics in the last
Never / rarely
1-5 years ago
6-12 months ago
Within the last 3 months
BACK
PART
3/4
How would you rate your current cognitive performance?
Optimal / no concerns
Slightly below baseline
Noticeably declined
Significant concern
BACK
PART
3/4
What stress management practices do you currently use?
Exercise / movement
Meditation / mindfulness
Breathing exercises
Social support
Time in nature
Journaling
Hobbies / creative activities
None
BACK
PART
3/4
What is your primary longevity goal?
Extend healthspan (quality of life, functional capacity, independence)
Prevent age-related diseases (avoid specific diseases: heart disease, diabetes, cancer)
Maintain independence (physical, cognitive, social independence)
Optimise biomarkers
General wellness optimisation
BACK
PART
3/4
Do you have risk factors for bone loss?
Family history of osteoporosis
Female, post-menopausal
Limited sun exposure
Sedentary lifestyle
History of fractures
None of the above
BACK
PART
3/4
When you get sick, how long does recovery typically take?
Less than 1 week
1-2 weeks
2-3 weeks
More than 3 weeks
BACK
PART
3/4
When do you experience fatigue most?
Morning / upon waking
Midday / post-lunch (energy crash after meal)
Late afternoon (3-5 PM slump)
Evening / consistent throughout day
Unpredictable pattern (no consistent timing)
BACK
PART
3/4
How does your mind feel at night?
Calm
Slightly active
Overthinking / racing
Anxious / stressed / wired
BACK
PART
3/4
How would you describe your fiber intake?
Very low
Low to moderate
Moderate to high
High
BACK
PART
3/4
Do you experience any of these symptoms?
Morning grogginess
Afternoon energy crash
Evening wired feeling
Cravings for sweet / salty
Weight gain despite diet efforts
Nighttime wakefulness
None of the above
BACK
PART
3/4
Which immune-related symptoms concern you?
Frequent colds / flu
Prolonged recovery
Delayed wound healing
Frequent throat infections
Recurrent oral infections
Skin infections
None
BACK
PART
3/4
Which of the following accompany your fatigue?
Brain fog / difficulty concentrating
Muscle weakness
Lack of motivation
Sleep disturbance
Frequent infections / low immunity
Digestive issues
None of the above
BACK
PART
3/4
Do you have any diagnosed inflammatory conditions?
IBS/IBD (Inflammatory Bowel Disease)
Food sensitivities (diagnosed or suspected)
Leaky gut concerns
None diagnosed
BACK
PART
3/4
How would you rate your anxiety?
None / minimal
Mild
Moderate
Significant
BACK
PART
3/4
Are immune concerns seasonal?
Year-round
Worse during winter
Worse during specific season
Depends on stress / activity levels
BACK
PART
4/4
Do you have any allergies to any drugs or supplements?
No allergies
Yes, to specific drugs
Yes, to specific supplements
Not sure
BACK
PART
4/4
Do you have any existing health conditions we should be aware of?
No
Yes
No
Thyroid imbalance
PCOS / PCOD (if female)
High BP
High cholesterol
Diabetes / prediabetes
Autoimmune condition
Others
BACK
PART
4/4
Are you currently being treated for this condition?
Yes
No
BACK
PART
4/4
Are you currently taking any medication?
Yes, ocassionally
Yes, daily
No
Prefer not to say
BACK
PART
4/4
Have you been diagnosed with any nutrient deficiencies?
No known deficiencies
Vitamin D
Vitamin B12
Iron
Omega-3
Calcium
Others
BACK
PART
4/4
When were you last tested for deficiencies?
In the last 6 months
6–12 months ago
Over a year ago
Never tested
BACK
PART
4/4
Are you currently taking any supplements?
No, I don’t take any
Yes, occasionally
Yes, daily
BACK
PART
4/4
What best describes your diet?
Vegetarian
Vegan
Non-vegetarian
Eggetarian
Pescitarian
Lactose free
BACK
PART
4/4
Do you work out or exercise regularly?
Yes
No
BACK
PART
4/4
How many days per week do you work out?
1–2 days
3–4 days
5–6 days
Daily
BACK
PART
4/4
What type of workout do you mainly do?
Strength training
Cardio
Mixed (Strength + Cardio)
Yoga / Pilates
Sports
Others
BACK
PART
4/4
How would you describe your daily activity level (excluding your workouts)?
Choose the option that best matches your typical day
Very Light - Mostly sitting (e.g., desk job, student)
Light - Mix of sitting, standing, and light movement (e.g., teacher, trainer, retail worker)
Moderate - Continuous gentle to moderate movement (e.g., nurse, technical operator)
Heavy - Strenuous or physically demanding work throughout the day (e.g., field technician with frequent travel, on-site installations, network engineer)
BACK
PART
4/4
How many hours do you sleep per night?
Less than 6 hours
6-7 hours
More than 7 hours
BACK
PART
4/4
Do you have any of these sleep issues?
No issues
Difficulty falling asleep
Waking up during the night
Early morning awakenings
Feeling unrefreshed in the morning
Irregular sleep schedule
BACK
PART
4/4
How would you rate your current stress levels?
Low
Moderate
High
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