At Anand Medical Spa, we advocate a holistic approach to your beauty, health and wellness, including an understanding of the factors that may be accelerating the aging process.  Please take a few minutes to complete this questionnaire so that we can assist you better.

How often do you feel stressed?

Question Title

* 1. How often do you feel stressed?

What do you consider the main source of your stress?

Question Title

* 2. What do you consider the main source of your stress?

Have you ever sought help to manage your stress?

Question Title

* 3. Have you ever sought help to manage your stress?

If so, did it help?

Question Title

* 4. If so, did it help?

Do you feel that you have aged due to any recent or chronic stress?

Question Title

* 5. Do you feel that you have aged due to any recent or chronic stress?

What activities do you do for fun or relaxation and how many times/week?

Question Title

* 6. What activities do you do for fun or relaxation and how many times/week?

Do you exercise and how many times per week:

Question Title

* 7. Do you exercise and how many times per week:

Please specify type of exercise

Question Title

* 8. Please specify type of exercise

In the past month, how often have you:

Question Title

* 9. In the past month, how often have you:

  All of the time Most of the time Some of the time Rarely Never
Had trouble sleeping?
Woke up earlier than desired?
Woke up for no reason during the night?
Felt tired during the day?
Do you feel you have aged due to your lack of sleep?

Question Title

* 10. Do you feel you have aged due to your lack of sleep?

How many cups of coffee or caffeinated beverages do you normally consume daily?

Question Title

* 11. How many cups of coffee or caffeinated beverages do you normally consume daily?

How many 8 oz. glasses of water do you normally drink daily?

Question Title

* 12. How many 8 oz. glasses of water do you normally drink daily?

Are you getting 3-5 servings of fruits and vegetables/day?

Question Title

* 13. Are you getting 3-5 servings of fruits and vegetables/day?

Do you usually:

Question Title

* 14. Do you usually:

Would you say your diet is balanced?

Question Title

* 15. Would you say your diet is balanced?

Do you eat organic foods?

Question Title

* 16. Do you eat organic foods?

Do you smoke?

Question Title

* 17. Do you smoke?

Do you drink?

Question Title

* 19. Do you drink?

Do you use sunscreen?

Question Title

* 20. Do you use sunscreen?

What supplements do you use, if any?

Question Title

* 21. What supplements do you use, if any?

What would you say is the primary factor in your aging?

Question Title

* 22. What would you say is the primary factor in your aging?

What is a positive action you are now taking to help prevent an accelerated Aging process?

Question Title

* 23. What is a positive action you are now taking to help prevent an accelerated Aging process?

What are you anti-aging and beauty, and heath and wellness goals? (Please specify)

Question Title

* 24. What are you anti-aging and beauty, and heath and wellness goals? (Please specify)

Would you like to schedule a consultation to address any of the above concerns?

Question Title

* 25. Would you like to schedule a consultation to address any of the above concerns?

Please provide us with your name and contact information, if you would like more information or to schedule a consultation:

Question Title

* 26. Please provide us with your name and contact information, if you would like more information or to schedule a consultation:

We look forward to helping you achieve your goals, and prevent the aging process from progressing.

T