Danbar for Life, LLC
"Health Optimization through Education, Nutritional Supplementation, Diet, Exercise, and Lifestyle Modification"
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Let's Get Started

These questions will allow us to build your custom lifestyle program.
** Please note, questions 1 through 5 are required.

1) What is your height?       feet    inches

2) What is your weight?      lbs.

3) Which age range, in years, are you in?
     18 - 25 26 - 35 36 - 45 46 - 55 56 - 65 66+

4) What is your gender?      female male

5) What is your waistline at the hips?      inches


6) Do you have any of the following medically diagnosed chronic health conditions, including diabetes mellitus, high blood pressure, cardiovascular disease or heart problem?
     no yes

7) Has your doctor started you on any medication to treat any of these or related conditions?
     no yes

8) Have you been compliant with taking your prescription medication?
     no yes na

9) What is your daily activity level?
     Inactive or sedentary [do not get any regular exercise]
     Minimally active [exercise less than 30 minutes per week]
     Mildly active [exercise 30 to 60 minutes per week]
     Moderately active [exercise 60 to 90 minutes or more per week]

10) Do you feel confident with your understanding of your health risk factors, BMI and weight classification when discussing it with your health provider, family and/or friends?
     no yes


11) Are you satisfied & comfortable with current weight and BMI as it relates to your health status and current weight goal?
     no yes

12) Are you at-risk for complications related to being overweight or obesity?
     no yes

13) Are you contemplating bariatric or weight loss surgery within the next year or so?
     no yes

14) Would you like to learn more about how to successfully start and implement a healthy lifestyle change-management program for health improvement and long-term weight control?
     no yes

15) Do you currently take multivitamins, vitamin D3, or other immune-enhancement supplements?
     no yes

16) Would you like to have a personal coach or take the lifestyle change process on by yourself?
     with a personal coach on my own






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