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Dietary Pattern (check all that apply):
Sun Exposure (How much time do you spend outdoors daily?)
<15 minutes
15–30 minutes
30–60 minutes
1+ hour
Other
Physical Activity (How often do you exercise?)
Rarely
1–2 days/week
3–5 days/week
Daily
Stress Levels (How would you rate your daily stress?)
Low
Moderate
High
Very High
Sleep Quality (Average hours of sleep per night?)
<5
5–6
7–8
9+
Dietary Intake Indicators (How many servings of fruits/vegetables do you eat daily?
0–1
2–3
4–5
6+
Protein Sources (Primary protein sources?)
Meat
Fish
Eggs
Legumes
Nuts/Seeds
Protein Powders
Whole Grains (Do you regularly consume whole grains?)
Yes
No
Dairy or Calcium-Rich Foods (Do you consume dairy or fortified alternatives?)
Daily
Several times/week
Rarely
Never
Symptom Checklist (Past 30 Days) Energy & Mood
Symptom Checklist (Past 30 Days) Skin, Hair, Nails
Symptom Checklist (Past 30 Days) Muscles & Bones
Symptom Checklist (Past 30 Days) Immune Function
Symptom Checklist (Past 30 Days) Digestive Symptoms
Symptom Checklist (Past 30 Days) Neurological
Specific Vitamin-Related Indicators (Vitamin D)
Specific Vitamin-Related Indicators (Vitamin B12)
Specific Vitamin-Related Indicators (Iron)
Specific Vitamin-Related Indicators (Magnesium)
Specific Vitamin-Related Indicators (Vitamin C)
Specific Vitamin-Related Indicators (Omega-3)
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