If you are like most people, I imagine there are specific goals you have for your health and your life. Perhaps you want more energy and are tired of always being tired. Maybe you have those nagging sweet cravings that you can’t seem to get under control. Or, perhaps it’s time to finally figure out how to look and feel great in your own body. Kindly answer this questionnaire and I'll reply with your type of chocolate within 48 hours.

1. PERSONAL INFORMATION

2. HEALTH INFORMATION

3. MEDICAL INFORMATION

4. FOOD INFORMATION - What foods did you eat often as a child?

5. FOOD INFORMATION - What is your food like these days?

6. Will family and/or friends be supportive of your desire to make food and/or lifestyle changes?

7. Do you cook?

8. Where do you get the rest from?

9. Do you crave sugar, coffee, cigarettes, or have any major addictions?

10. The most important thing I should change about my diet to improve my health is:

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