Ankieta zdrowia Step 1 of 34 2% What is your name?(Required) Enter your e-mail address(Required) (Required) In order to receive information on suggested supplementation prepared based on the results of a personalized interview in the form of a questionnaire, I consent to the processing of my personal data, including those about my health, in accordance with the Privacy and Cookies Policy of The Rich Supplements Ltd. Gender(Required) Woman Man Non-binary What is your height in centimetres?(Required) Up to 140cm From 141cm to 160cm Over 160cm What is your height in centimetres?(Required) Up to 140cm From 140cm to 170cm Over 170cm What is your current body weight in kilos?(Required) Under 40kg From 41kg to 60kg Over 60kg What is your current body weight in kilos?(Required) Under 50kg From 50kg to 70kg From 70kg to 85kg Over 85kg Are you currently taking any supplements?(Required) Yes No How many different supplements do you take per day?(Required) 1-4 More then 5 Have you taken any supplements in the past?(Required) A long time ago Never Yes I have just finished taking Do you take supplements regularly?(Required) Yes, every day No, I sometimes forget What is your main purpose for taking the supplements?(Required) Support with chronic problems/diagnosed illnesses I want to feel good and take care of myself Recommendation from a doctor Looking for something new Do you have problems focusing or concentrating?(Required) Yes No Do you have a memory problem?(Required) Yes No Do you have any skin problems?(Required) Dry skin Wrinkles Acne or rash Skin allergies Oily skin I don't have Do you have any hair problems?(Required) Dry and damaged hair Hair loss Oily hair I don't have Are you experiencing muscle spasms?(Required) Yes – often Yes – occasionally No Do you experience digestive problems?(Required) Yes – often Yes – occasionally No Does your family have a history of cardiovascular problems?(Required) Yes No How often are you sick?(Required) I don't get sick 1-2 times per year 5-6 times per year Very often - once a month Do you feel regenerated after sleep?(Required) Yes No Do you have problems falling asleep or waking up at night?(Required) Yes No Sometimes Do you have a problem with energy during the day?(Required) I feel drops in energy during the day I feel very tired I have no problems When do you have lower energy levels during the day?(Required) When I wake up Afternoon After meals I don't feel tired How often do you feel stressed?(Required) Rarely Sometimes Most of the time I have no problems with stress Twój stres można opisać jako?(Required) Niepokój/lęk Pogorszenie nastroju Pogorszenie pamięci i koncentracji What is the form of your work?(Required) Sitting Manual Mixed Do you lead a healthy lifestyle?(Required) Yes No I want to start How often do you eat fish or seafood?(Required) One time per week Very rarely - less than once a week I don't eat I don't eat, I'm allergic How often do you eat meat?(Required) One time per week More than 3 times a week I don't eat Do you include vegetables and fruit in your diet?(Required) Yes, I eat fruit and vegetables every day Yes, I eat fruit and vegetables twice a week I don't eat fruit and vegetables Do you consume alcohol?(Required) Yes No How often do you consume alcohol?(Required) Less than once a week Once a week More than once a week Do you smoke cigarettes?(Required) Yes No How much do you smoke cigarettes?(Required) A pack or more of cigarettes a day A packet of cigarettes a week Less than a packet of cigarettes a month Do you use the computer more than 6 hours a day?(Required) Yes No Do you have dry, red or irritated eyes?(Required) Yes, often Yes, but rarely No
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