VitaminLab | Questionnaire - VitaminLab | Custom and Personalized Vitamins

Lifestyle

CHOOSE ALL THAT APPLY

Diet

IN THE AVERAGE DAY

I consume 2 or more servings of seafood in the average week
I consume 5 or more servings of fruits and vegetables
I eat at least 3 meals

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Lifestyle

IN THE AVERAGE WEEK

I spend less than 20 minutes per day in direct sunlight or suffer from Seasonal Affective Disorder
I get the recommended 75-150 minutes of aerobic exercise every week
I smoke cigarettes or am exposed to second-hand smoke regularly

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Sleep, Energy, Stress

IN THE AVERAGE WEEK

I am under high levels of mental/ emotional stress
My daytime energy is 8+ on a 10 point scale
I get at least 6 hours of restful sleep each night

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3 of 3

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My concerns or health goals are:

Please Choose 3 to 5 goals

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Lifestyle

CHOOSE ALL THAT APPLY

Diet

IN THE AVERAGE DAY

Lifestyle

IN THE AVERAGE WEEK

Sleep, Energy, Stress

IN THE AVERAGE WEEK

Do you have any dietary restrictions?

Select all that apply to you

I am a:

Health History

What are your current medical conditions? (skip if none)

Medications

What current medications do you take regularly? (skip if none)

Finish

Upload any of these for us to our HIPPA Compliant Server
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Information

Select your service:

Take Nutrition Quiz

Create Formula/Stack

Upload DNA

First a few questions about you:

My concerns or health goals are:

Please Choose 3 to 5 goals

Where do you live?

Lifestyle

CHOOSE ALL THAT APPLY

Diet

IN THE AVERAGE DAY

Lifestyle

IN THE AVERAGE WEEK

Sleep, Energy, Stress

IN THE AVERAGE WEEK

Do you have any dietary restrictions?

Select all that apply to you

I am a:

Health History

What are your current medical conditions? (skip if none)

Medications

What current medications do you take regularly? (skip if none)

Finish

Upload any of these for us to our HIPPA Compliant Server$49 is applied as credit to their supplement

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Upload any of these for us to our HIPPA Compliant Server
$49 is applied as credit to their supplement

Vitamin and supplement
expert knowledge,