Your Energy Level Indicators 

Please answer the following questions and once we have received your responses we will contact you to arrange your free 20 minute phone consultation 

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* 1. Please enter your personal details

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* 2. To what extent do the following phrases apply to you?

  Always Sometimes Rarely Never
I am wide awake within 15 minutes of getting up
I need tea, coffee or something sweet to get me going in the morning
I crave chocolate, sweet foods, bread, cereal or pasta
I have energy slumps during the day or after meals
I have mood swings
I have difficulty concentrating
I get dizzy or irritable if I go 6 hours without food
I overreact to stress
My energy is really low
I feel too tired to exercise

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* 3. Please describe how well you sleep. If your sleep is disturbed please let us state whether this is related to someone else (husband, child).

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* 4. What is your weight?

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* 5. What is your height?

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* 6. How many glasses of water do you drink each day?      

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* 7. How many cups of tea or coffee do you drink each day?   Specify which kind e.g. decaf, coffee shop, herbal       

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* 8. On an average day how many portions of fruit do you eat?

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* 9. On an average day how many portions of vegetables do you eat?

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