3-minute assessment

Personalized Wellness Assessment

个性化健康评估

This questionnaire is for general wellness screening and care planning. It does not provide a medical diagnosis.

About you｜基本资料

Full name｜姓名 Phone｜电话 Email Age range｜年龄段

Primary wellness goal｜主要目标

Pain relief
改善疼痛 Sleep
改善睡眠 Stress
压力管理 Digestion
改善消化 Women’s health
女性健康 Body composition
体重与代谢

Main concern｜主要困扰 How long has this been present?｜持续时间

0 = very poor / none, 10 = excellent / severe where indicated.

Sleep quality｜睡眠质量 5 Energy level｜精力 5 Stress level｜压力程度 5 Digestive comfort｜消化舒适度 5 Pain severity｜疼痛程度 5 Readiness to improve｜改善意愿 8

Interested in InBody assessment?｜是否希望做InBody? Preferred next step｜您希望下一步 Additional notes｜补充说明

Prototype only: connect this form to your approved WordPress form or secure workflow before launch.