

What is your age?
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What is your gender?

What is your weight and height?
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How is your energy level on a normal day?

How often do you get stressed?

How do you sleep?

How is your memory and concentration?

How often do you
exercise each week?

How would you describe
your weekly exercise?

Do any of your cleaning products
contain bleach or ammonia?

How many times per week
do you eat fruit?

How many times per week
do you eat vegetables?

How many times per week
do you eat whole grains?

How many times per week
do you eat dairy?

How many times per week do you eat omega-3-rich fish, such as salmon?

How many 8-ounce glasses of water do you drink each day?

How many times per week do you consume sugary drinks (ex: soda, juices, etc.)?

How many times per week do you eat unhealthy snacks or fast food?

What do you typically
eat for breakfast?

Do you purchase
organic foods?

Do you have any dietary restrictions?
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Please select which of the following apply to you

Please identify your top 3 health goals.
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How much would you spend each day
to achieve your optimum health?
Thank you for completing your Shaklee Healthprint!
Please enter your name and email below to have your results emailed to you.
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By clicking “Get Results” you consent to share your responses with Shaklee U.S., LLC; allow Shaklee U.S., LLC to share your responses with your Shaklee Distributor and Business Leader, if different; and allow Shaklee U.S., LLC, your Shaklee Distributor, and your Shaklee Business Leader, if different, to retain your responses as part of their records.
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