SwiftStart Survey: Your Ticket to Program Enrollment Welcome to your SwiftStart Survey: Your Ticket to Program Enrollment Full Name Email Address Country of residence Contact number Age Most recent measure: Height (cm/feet) Please specify the unit 1 out of 4 How often do you eat outside meals or indulge in fast food/fried/desserts? Please select your answer Once a week 1-3 times a week Everyday Rarely For Females: Menstrual Cycle Please select your answer Regular Irregular NA Family Medical History Medical Condition/health Concern (if any) What is your goal to join this program? How has your digestive health been (Any bloating, flatulence, acidity, constipation, loose stools) 2 out of 4 Your current dietary habits Vegan (Plant-based) Ovo-vegetarian (do not eat meat, seafood and dairy foods, but include eggs and plant foods) Lacto-vegetarian (do not eat meat, seafood and eggs, but include dairy foods and plant foods) Lacto-ovo-vegetarian (do not eat any meat and seafood, but include dairy foods (such as milk), eggs and plant foods) Pescatarian (do not eat any meat, but include seafood, dairy foods, eggs and plant foods) Non-vegetarian (consume plant and animal based foods) None Dietary limitations or Food intolerances or Known Allergies Do you eat your food: Please select your answer Slowly (15-20 minutes) Fast (5 minutes) No fixed time Please fill up your past 24 hour diet recall (timings and quantities are essential, please describe in detail) E.g. 7:00am 1 cup Lemon water with honey 9:00am Breakfast 2 whole eggs boiled Please list the medications &/or supplements you currently are on (if any) On average, your water intake per day: Please select your answer < 1 litre per day 1-2 litre per day 2-3 litre per day > 3 litre per day 3 out of 4 What is your sleep duration and sleep quality per night? Specify your sleep and wake up time Please outline your exercise schedule Please feel free to add any more details that you think might help us support you better. Medical parameters would also help. 4 out of 4 Time's up
