Age Range ^* Select Age Range 16-20 21-30 31-40 41-50 51-60 61+

Gender^*

What are your primary wellness goals?^*

On a scale of 1 to 10, how satisfied are you with your current level of well-being? (10 being really satisfied) ^* Select satisfaction level 1 2 3 4 5 6 7 8 9 10

Do you have any specific health challenges or concerns you'd like to address?^*

How often do you engage in physical activity or exercise?^* Select frequency of physical activity Rarely or never Once a week 2-3 times a week 4-5 times a week Daily

What is your current dietary approach or eating habits?^* Select dietary approach Standard American diet Mediterranean diet Low-carb or keto Vegetarian Vegan Other (please specify)

Do you have any dietary restrictions or preferences?^*

Please select any symptoms you are currently experiencing: ^*

Are you currently taking any vitamins or supplements?^*

How important is overall wellness in your life right now? ^* Select importance of overall wellness Not important Somewhat important Moderately important Very important Extremely important