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We are excited that you are joining The Molecular Fitness Lifestyle^TM, and we look forward to guiding your journey to optimal wellness.
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We would greatly appreciate it if you would please take a few minutes to answer the following optional questions so that we can provide you with the best possible support. Please rest assured that these questions are for HealthConnexin internal use only and will not be shared with any other companies or organizations.
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How would you rate your health?
Which are your top 2 health concerns?	CancerHeart DiseaseDiabetes OsteoporosisAlzheimer’s diseaseOcular (eye) disease ArthritisHypothyroidism (obesity)Aging
Do you take nutritional supplements on a regular basis?
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Do you participate in any stress reduction techniques (e.g yoga, massage, meditation)?
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What are your main health goals (select all that apply)?
Maintain my current good health and prevent the onset of disease Overcome current illness and/or specific ailments Achieve optimal physical performance on a daily basis Achieve optimal mental focus and alertness on a daily basis Lose weight and/or maintain a healthy weight

Where do you currently get your health information (select all that apply)?
Health and Nutrition BooksBody & Soul magazine Men’s Health MagazineNatural Health Magazine Oprah MagazineShape Magazine Yoga JournalHealth Newsletters Dr Weil WebsiteHealth Insurance Website South beach Diet WebsiteGym/Gym Newsletter NutritionistChiropractor Drug Store/PharmacistFitness Magazine Muscle & FitnessNutrition Magazine Self MagazineWeight Watchers Magazine Other Health Related MagazinesWebMD Website iVillage WebsiteWellness Letter Website Weight Watchers WebsiteOther Internet Sites PhysicianSpa Fitness Trainer

Where do you primarily shop for food and nutritional supplements (select all that apply)?
SupermarketDrug Store Whole FoodsWild Oats Vitamin ShoppeOther Health Food Store GNCMass Merchandiser (Walmart, Target) Great Earth VitaminsOther Supplement Store InternetMail Order Practitioner

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