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    1 To start your journey with Amrit, please agree to Amrit's Privacy Policy and Terms of Use.

    Yes, I acceptNo, I don't accept

    2Please tell us your first name to begin: *

    3What is the best email to reach you? *

    4And the best phone number? *

    Numbers only please

    5Do you use any wearable devices to track your daily sleep and activity level?

    Having access to your activity data will enable your wellness guide to customize your personalized wellness roadmap.

    6What is your gender?

    7Your guide would like to know you a bit better to customize your wellness road map. Let's begin with your age:

    8And where were you born (Country, state, or city)?

    Our cultural heritage and identity play important roles in how we define and pursuit personal wellbeing

    9Where do you currently live (Country, state, or city)?

    10What is your relationship status?

    11What is your occupation?

    12How many hours do you work in a typical week?

    13Do you have any kids?

    14Do you have any pets?

    15Next, your wellness guide would like to understand more about your health information.
    Let's begin with: what is your weight?

    Please indicate unit (lbs. or kg)

    16And what is your height?

    Please indicate unit (m/cm or ft/in)

    17Would you like your weight to be different?

    18How would you like your weight to be different?

    19What was your weight a year ago?

    Please indicate the unit (lbs. or kg)

    20What is your ideal weight?

    Please indicate the unit (lbs. or kg)

    21Do you currently follow any particular diets?

    22What is your food like on a typical day this week?

    afor breakfast

    bfor lunch

    cfor dinner

    das snack

    eas drink

    23Do you experience any digestive issues, such as constipation, diarrhea, or gas?

    24Do you cook?

    25What percentage of your food is home-cooked in a typical week?

    26Where do you get the rest of your meals from?

    27Do you crave sugar, coffee, cigarettes? or any other dependencies?

    28Do you have current or past serious illness, hospitalizations, or injuries? Please specify

    Well done! Just a couple more questions on your health history!

    29 What is/was the health of your Father?

    a What is/was the health of your Mother?

    30How is your sleep?

    E.g., Do you experience difficulties falling asleep? Do you wake up at night?

    31How many hours do you typically sleep each night?

    32 At what point in your life did you feel at your best? Why?

    33 What are your main health concerns, if any?

    Well done so far, Just a couple more questions left!

    34In a typical week, how many days do you engage in mindfulness exercises (yoga,meditation, journaling, etc.)?

    35What kind of workouts do you do?

    a.Other Exercise

    36 Do you take any supplements or medications? Please list:

    37 What type of spa services are you most interested in enjoying at Amrit?

    38Amrit Resort believes in 5 Pillars of Wellness, Fitness, Relaxation, Meditation, Nutrition and Sleep. On a scale of 1 to 5 rate which pillars you are most interested in working on. (1 being the highest, 5 being the lowest)

    A. Fitness

    B. Relaxation

    C. Meditation

    D. Nutrition

    E. Sleep

    39Based on your desired pillar of focus, in 1-3 sentences what are your short- and long-term goals for (Sleep, Nutrition, Meditation, Relaxation, Fitness)?

    40Considering your pillar of choice, what specific goal or change would you like to achieve?

    41In 1-3 sentences, what is your key motivating factor driving your desire for change?

    42What is your preferred contact method in between sessions?

    43How often do you prefer contact?

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