Questionnaire for LuckyFit LuckyFit » Questionnaire for LuckyFit QUESTIONNAIRE for LuckyFit Programme* StandardFULL DETOXAntistressPlusWeekend GENERAL QUESTIONS: Name and surname*: Age*: years Weight*: kg. Height*: sm. E-mail address*: Telephone number*: How did you find out about LuckyFit?* from friendsGooglefrom Aparthotel Lucky Banskoother What's the purpose of your participation in LuckyFit? (please choose one of the options) weight lossdetoxificationanti-stressyogagood timeI'm accompanying someoneAnother Is it your first time in LuckyFit?* YesNo – It is the second timeNo - more than two times Is this your first detoxification therapy?* YesNo How many times do you go through a detoxification therapy in a year?* 1234 Have you ever starved for healing purposes (even if for a day)?* YesNo Would you undergo a 36-hour starvation?* YesNo What part of your body would you like to cleanse?* The whole organismLiverSpleenBlood systemLymphDigestive system LIFESTYLE What food regime are you following?* Standard (including meat)VegetarianVeganAnother (Fill in the box) How many times a day do you eat? 12345 What kind of food do you not consume? Do you smoke? NoYesI smoke less than 10 cigarettes a day Do you drink alcohol? NoYesRarely LEVEL OF PHYSICAL TRAINING: How many steps a day do you take? Under 1000Between 1001 and 5000Between 5001 and 10 000Over 10 000 What type of work do you do in terms of physical activity? Mostly physical activityThere is also physical activityWithout physical activity How many times a week do you exercise for a minimum of 45 minutes? I do not exerciseUp to 2 times a weekBetween 2 and 4 times a weekMore than 4 times a week How would you determine your level of physical endurance? I get very tired after exercisingI do not feel very tired after exerciseI do not get tired after exercise How often do you go on a mountain hiking? I don‘t do mountain hikesOnce in a monthBetween 2 and 4 times a monthMore than 4 times a month What is the duration of your mountain hikes? Under 2 hoursBetween 2 and 4 hoursMore than 4 hours HEALTH CONDITION – GENERAL QUESTIONS: Note the presence / absence of a symptom and its severity of appearance: Heart problems NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Chest pain during physical activity NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Chest pain without physical activity NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Dizziness NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Loss of consciousness NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Do you have any of the following complaints: joint stiffness, joint pain after exercise, back pain after exertion, shortness of breath during exercise, palpitation after exercise, chest pain? NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Do you have any of the following symptoms: constant weight gain for no reason, swelling of legs and ankles, difficulty losing weight when you are on a diet, more fatigue than before? NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Do you lose weight if you are only on a diet? NoYes Constipation NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe High blood pressure NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Low blood pressure NeverSometimes, but appear slightlySometimes and they are severeOften but appear slightlyOften and they are severe Did you do the blood tests from the list we sent you? YesNo Blood Sugar Level (Value): info@luckyfit.eu Are you currently taking medicines for high blood pressure or for heart problems? NoYes Are you currently taking another type of medication? NoYes Have you had a serious injury or surgery in the last 2 years? NoYes Note "Yes" in case of pregnancy and specify the month of pregnancy. NoYes Do you have another reason why it is not advisable for you to exercise? NoYes
