fire25 questionnaire

F.I.R.E QUESTIONNAIRE FORM

* Indicates required field

Name *

First

Last

Email *

Please Select Your Body Type (Letter) *

Please list any food allergies *

Snacking Habits *

How often do you drink alcohol? *

How much water do you drink per day? *

I don't drink water Very little Moderately throughout the day It's all I drink

Are you a stress eater / bordem? *

Yes No

Do you have any inflamatory issues? *

Yes No

Do you have a busy daily schedule? *

Yes No

How often do you eat out? *

Do you know how to cook? *

Yes No

Describe your biggest struggle with maintaining consistency in reference to a healthier eating lifestyle? *

Submit