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.

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* 1. How often do you feel stressed?

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

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

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* 4. If so, did it help?

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

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

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

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* 8. Please specify type of exercise

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* 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?

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

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

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

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

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* 14. Do you usually:

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* 15. Would you say your diet is balanced?

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* 16. Do you eat organic foods?

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* 17. Do you smoke?

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* 19. Do you drink?

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* 20. Do you use sunscreen?

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

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

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

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

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

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* 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.

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