Online Questionnaire Online Questionnaire Name* First Last Email* Phone*1. Would you like to increase your ENERGY levels or check they are optimal?*YesNo2. Would you like to decrease your chances of becoming ill?*YesNo3. Do you wish to know whether you're getting the nutrition your body requires?*YesNo4. Do you want to ensure that your mental alertness and concentration are optimal?*YesNo5. Do you want to increase your sports stamina and performance?*YesNo6. Do you suffer from any medical condition or illness?*YesNoPlease specify which medical condition or illness you suffer from.7. Do you want to increase your libido?*YesNo8. Would you like to lose weight?*YesNo9. Do you suffer from constipation, bloating, loose bowels, stomach pain/discomfort or acid reflux?*YesNo10. Would you like us to contact you for a free 10 minute health discussion? (within Auckland area only)*YesNo