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Note: If you are pregnant or currently breastfeeding, please consult your doctor before taking NextVits.

Gender

Your Age:

Your Height: cm

Your Weight: kg

Are you pregnant or breastfeeding?

(if yes, please consult with your health practitioner before taking any supplements)

What are the top health concerns you would like to solve?

Do you suffer from any allergies?

(IMPORTANT: Our supplements contain no: dairy products, eggs, fish, crustaceans, tree nuts, wheat, gluten, peanuts or soy.
If you are allergic to any ingredients other than these, please write down here and consult your physician prior to taking our supplements.)

Do your family members have the following condition(s)?

On average, how many servings of fruit and vegetables do you have every day?

(One serving being the equivalent of one apple or one cup of leafy vegetables - about the size of a small fist)

On average, how many servings of dairy, such as milk, cheese, or yoghurt, do you have every day?

(One serving of dairy bejing the equivalent of one cup of milk or yoghurt and one ounce of cheese about the size of a six face dice)

On average, how many portions of oily fish such as salmon, tuna, mackerel, or sardines do you consume per week?

Do you smoke?
How many cigarettes do you smoke a day?

On average, how many alcoholic beverages do you have per day?

(One alcoholic beverage is equivalent to one glass of beer, wine, or cocktail)

What are your fitness goals?

(You may select more than 1 prior to taking our supplements.)

What types of fitness training programmes are you on or will do in future?

Are you eating well and/or having regular meals?

(You may select more than 1)

What best describes your diet?

What best describes your current health status?

What supplements, if any, are you currently taking?

What supplements are you currently taking for workouts training programmes?

What is your blood pressure?

What is your cholesterol level?

What is your blood glucose level?

What medications are you currently taking?

Are you deficient in the following vitamins or minerals?

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Gender

Your Age

Your Height

Your Weight

Are you pregnant or breastfeeding?

What are the top health concerns you would like to solve?

Any other, please specify

Do you suffer from any allergies?

(IMPORTANT: Our supplements contain no: dairy products, eggs, fish, crustaceans, tree nuts, wheat, gluten, peanuts or soy. If you are allergic to any ingredients other than these, please write down here and consult your physician prior to taking our supplements. )

Any other, please specify

Do your family members have the following condition(s)?

Any other, please specify

On average, how many servings of fruit and vegetables do you have every day?

On average, how many servings of dairy, such as milk, cheese, or yoghurt, do you have every day?

On average, how many portions of oily fish such as salmon, tuna, mackerel, or sardines do you consume per week?

Do you smoke? How many cigarettes do you smoke a day?

On average, how many alcoholic beverages do you have per day?

What are your fitness goals?

Any other, please specify

What types of fitness training programmes are you on or will do in future?

Any other, please specify

Are you eating well and/or having regular meals?

Any other, please specify

What best describes your diet?

Any other, please specify

What best describes your current health status?

Any other, please specify

What supplements, if any, are you currently taking?

Any other, please specify

What supplements are you currently taking for workouts training programmes?

Any other, please specify

What is your blood pressure?

What is your cholesterol level?

What is your blood glucose level?

What medications are you currently taking?

Any other, please specify

Are you deficient in the following vitamins or minerals?

Any other, please specify

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