Feedback Form July 4, 2020 Feedback Form Name0/23E MailAddress0/177Please provide your full addressHave you tried to lose weight or make lifestyle changes in the past? Yes No Do you do exercise? Yes No How many hours you sleep in a night? 5-6 hours 7-8 hours none of the above Do you expose your skin to sunlight? Yes No Do you currently take any vitamins or supplements? Yes No Do you smoke? Yes No Do you have any food allergies or food intolerances? Yes No How often do you eat fast food or go to a restaurant? 0‐1 times/month 2‐3 times/month 1‐2 times/week 3‐4 times/week 5+ times/week How often do you drink alcohol? 0‐1 times/month 2‐3 times/month 1‐2 times/week 3‐4 times/week 5+ times/week How much water should you take per day? 4-5 glasses 9-10 glasses Are you happy with your weight? Yes No What is your current stress level? Moderate High Do you feel pain in your body? Yes No What is Current Health Problems? Diabetic Cholesterol Do you crave sweets? Never Occasionally Often Do you face the problem of brittle hair or facing hair loss? Yes No Do you have skin rashes or any other issues that just don’t go away? Yes No Any Feedback Fields with (*) are compulsory.