YOUR FREE HEALTH AND ENERGY ASSESSMENT

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Your Assessment Form

How healthy and energetic do you feel?

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9

Step 1

Health Assessment

Tired most of the time

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

Overweight

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

Prone to hormonal symptoms

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

Suffering from poor memory and concentration

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

Step 2

Low or depressed

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

Plagued by dry skin in need of daily moisturisers

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

Having difficulty sleeping

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

Often feeling anxious or stressed

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

Step 3

Prone to indigestion or bloating after food

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

Often constipated (you rarely go twice a day)

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

Suffering from dark circles or bags under your eyes

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

Step 4

Total Score:

Ideal target: 14 or less

Step 5

Energy & Blood Sugar Control:

I still feel tired 20 minutes after getting up

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

I often crave chocolate, sweet foods, bread, cereal or pasta

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

I need tea, coffee or a cigarette, or something sweet to get me going in the morning

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

I often have energy slumps during the day or after meals

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

Step 6

I often crave something sweet/coffee after meals

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

I often have mood swings or difficulty concentrating

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

I get up dizzy or irritable if I go 4 to 6 hours without food

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

I often overreact to stress

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

Step 7

I have less energy than I used to

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

I often feel too tired to exercise

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

I am gaining weight / finding it harder to lose weight

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

Step 8

Total Score:

Ideal target: 16 or less

Step 9

Please fill in your details below

First Name

Surname

Contact Number

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

This is not only how you could be, this is how you should be

I know I can help you get what you want – Don’t wait!

Be the CEO of your health

No matter your role in life, there is none bigger or more important than being the CEO (the chief executive officer) of your own health. Whether you believe it or not, you have as much control over your own health and happiness as a CEO has over the success of their company — and often much more.

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YOUR FREE HEALTH AND ENERGY ASSESSMENT

Your Assessment Form

How healthy and energetic do you feel?

Health Assessment

Ideal target: 14 or less

Energy & Blood Sugar Control:

Ideal target: 16 or less

Please fill in your details below

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

This is not only how you could be, this is how you should be

I know I can help you get what you want – Don’t wait!

Be the CEO of your health

Contact Me

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