Kit Registration

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Let’s get started

Kit ID (if applicable)

Name

Date of birth

Gender

Weight (kg) *

Height (cm) *

Email

1. Do you smoke?

2. How many glasses of alcoholic drink do you drink per week? (E.g beer, wine, sake, cocktails, whiskey, brandy etc)

How often do you exercise per week? (Eg. cardio exercises at the gym, aerobics, running, cycling)

Do you feel sufficiently rested?

Do you suffer from stress?

Do you have a physically-demanding job?

How much time do you usually spend in the sun daily (without sunscreen)?

How many servings of vegetables do you eat daily? (1 serving is 1 cup of cooked vegetables or a side plate of salad)

How many times do you eat fish per week?

How many times do you eat meat per week?

Are you a vegetarian?

Do you eat on a regular basis “junk food” eg. potato chips, candy bars, processed snacks?

Do you drink regularly sweetened beverages? (with sugar or artificial sweetener such as Equal)

Do you drink regularly carbonated soft drinks?

Pls tick if you have any of the conditions below

Please provide more details if you tick any of the above conditions.

Any allergies?

Please provide more details if you tick any of the above conditions.

Diseases

Please provide more details if you tick any of the above conditions.

Many drugs are depleting the body of vital nutrients. Please mark those drugs you are currently taking.

Other

For Women Only

Are you breastfeeding?

Are you taking any hormonal contraceptions?

Health Goals

Other