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Your Wellness Resource Center Phone: 1-800-749-6861

Uniquely You Wellness Survey

In order to relate your personality type to possible health problems, complete the following survey. This is an anonymous questionnaire. You don't have to give us your name and address or phone number. All we need is your email address to send you a copy of your personality profile. Be honest and accurate with your answers so we can collect enough statistical data to formulate valuable scientific research. We are asking people to help with this short wellness survey to see how different personalities and behavior relate to specific health problems, and what products and life-style changes may help. Please respond accurately!
 
You must first complete your Wellness Survey before your Personality Profile questionnaire. You will only be able to have one FREE Personality Profile every 3 months, but must first complete the Wellness Survey again to see if there has been any changes. If you would like to complete another Personality Profile without waiting 3 months, go to www.uniquelyyou.net to complete another profile starting at only $6.(Couples, Parents, or Child.0

Enter your Email ID :
Enter your Password :
 
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Gender?
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Age?
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Height?
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Weight (without clothes) in pounds?
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Race?
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Marital Status?
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Employment?
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Hours working per week?
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Salary Level Per Year?
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Education?
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General Health?
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Strength Exercising?
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Cardio Vascular Exercising (Walking or Running)?
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Stretching Exercising?
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Nutrition?
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Vitamins / Supplements (Brands used)?
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Vitamins / Supplements (Taking)?
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Vitamins / Supplements (Specific ones currently taking)?
All None        
Alfalfa B-Complex C Calcium
Cal-Mag Caratomax Cholesterol Regulation Soothing Complex
CoQHeart CorEnergy Defend & Resist E
Essential Omega-3 Complex E-Z Gest Fiber
Garlic Gentle Sleep Complex (Valerian) GLA Glucose Regulation Complex
Herb-Lax (laxative) Iron Immune Building Complex Instant Protein
Joint Health Zinc Lecithin Liver DTX
Memory Optimizer Mental Acuity Menopause Balance Complex Moodlift Complex
Multi-Vitamin Optiflora Probiotic Pain Relief Complex Performance Sports Drink
Physique Workout Maximizer Saw Palmetto Soy Protein Stomach
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Have you been diagnosed with (check which ones)?
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All None        
Heart Disease Diabetes Hypertension / High Blood Pressure Cancer
ADD or ADHD Arthritis AIDS (HIV)
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Blood Pressure?
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Cholesterol?
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Cardio (Heart) Health :Do you now have or have had heart problems?
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Digestive Health :Do you now have or have had digestive problems?
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Do you now have or have had immunity problems?
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Do you now have or have had women's problems?
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Do you now have or have had joint pain problems?
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Do you now have or have had memory problems?
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What health problems do you currently have and need to improve?
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All None        
Energy Immune System Bone Density Oxygen in Blood
Choline Relieve Stress Strengthen Heart Digestion / Stomach
Minerals Menopause Cholesterol Regulation Blood Pressure
Pain Relief Joint Health Glucose Regulation Prostate
Weight Management Mental Outlook / Memory Sleep / Relaxation Sports Nutrition
Attention Deficit Liver Detoxifying Air Purification
Water Purification Allergies Circulation Skin Health
Hair Loss Anger Manager Other Environmental-Friendly Household Cleaners
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Would you like a FREE consultation with Dr. Mels and Phyllis Carbonell?
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If so, what is your phone number?
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How honest and accurate have you been with your answers? (This is very important for our research. It will not affect your personality profile.)
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How did you hear about Wellness Dynamics?
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to continue to your FREE Personality Profile Questionnaire OR
to Save Now if you need to leave this survey and want to return later