lifeallign

Mission Statement

To help chiropractors meet their practice goals and individuals and companies meet their weight loss and health goals.

Save your family's life!

FREE Report: The 4 Things You MUST Do to Optimize Your Health and Improve Your Family's Life.
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Health Survey
Last Name (*)
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First Name (*)
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Company Name (*)
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If not listed, what's your company name?
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Email (*)
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Phone (*)
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Height in inches, ex) If you are 5'4", enter 64 (*)
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Weight, ex) If you weigh 165 pounds, enter 165 (*)
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I exercise a minimum of 20 minutes per day, 3 days per week. (*)
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I drink a minimum of 8 glasses (64 ounces) of water every day. (*)
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I eat a minimum of 5 servings of fruits and vegetables every day. (*)
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I take a multi-vitamin most days. (*)
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I sleep, on average, 7 hours or more every night. (*)
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I feel alert and energetic all day most days. (*)
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I handle stress well and participate in enjoyable activities regularly. (*)
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In the past 30 days I have experienced:
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Which problem bothers you most?
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How long has this problem existed?
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Does this problem ever affect your mood, attitude, or energy levels? (*)
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Does this problem ever affect your daily activities at home or work or while exercising? (*)
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Does this problem ever affect your relationships with family, friends, or co-workers? (*)
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If you could get rid of this problem, would you want to? (*)
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