About You

Your Name & Email Address

We'll use this to personalise your report and send it to you.

Full name *

Please enter your full name

Email address *

Please enter a valid email address

Health Goals

Which areas would you like to focus on improving?

Select all that apply to you.

High blood pressure / hypertension High cholesterol (LDL or total cholesterol) Blood sugar management / pre-diabetes / diabetes Arterial plaque / atherosclerosis

Please select at least one option

Current Supplements

Tell us about your current supplements and medications

This helps us avoid interactions and build on what you're already doing.

What supplements are you currently taking? *

Please tell us about your supplements (or type "None")

How long have you been taking each supplement? *

Please provide this information

Are you currently taking any medications? If so, what are they? *

Please provide this information

What have you tried so far? What has worked and what has not worked?

Health Markers

Your current health numbers

Share what you know — it's okay if you don't have exact figures.

What is your current blood pressure reading (if known)? *

Please provide your blood pressure or type "Unknown"

What is your current cholesterol level (total, LDL, HDL, triglycerides - if known)? *

Please provide your cholesterol levels or type "Unknown"

What is your current fasting blood sugar or HbA1c level (if known)? *

Please provide this information or type "Unknown"

Do you have any other health conditions? *

Please provide this information

Are you pregnant, nursing, or planning to become pregnant? *

Yes No Not applicable

Please select an option

Your Diet

Tell us about your eating habits

There's no judgement here — we just need an honest picture.

Describe your typical daily eating pattern (breakfast, lunch, dinner, snacks)

How many servings of fruit and vegetables do you consume daily? *

Please answer this question

How often do you eat processed or fast foods per week? *

Please answer this question

Do you add salt to your meals? *

Yes, regularly Sometimes Rarely / Never

Please select an option

Eat packaged foods frequently? *

Yes Sometimes No

Please select an option

Your Diet (continued)

A few more questions about what you eat and drink

How much red meat, poultry, and fish do you eat per week? *

Please answer this question

Do you consume sugary drinks, and if so, how often? *

Please answer this question

How much water do you drink daily? *

Please answer this question

Do you drink alcohol? If yes, how many drinks per week? *

Please answer this question

How many cups of coffee do you drink per day on average? *

Please answer this question

Diet Preferences

Your food preferences and challenges

This helps us make recommendations you'll actually enjoy.

Do you follow any specific dietary pattern? *

Please answer this question

What are your biggest dietary challenges? *

Please answer this question

What are your favourite healthy foods? *

Please answer this question

What are your least favourite foods or food you refuse to eat? *

Please answer this question

Do you cook? *

Yes, regularly Sometimes Rarely / Never

Please select an option

Do you prefer simple recipes or are you comfortable with more complex cooking? *

Simple and quick recipes Comfortable with more complex cooking A mix of both

Please select an option

Do you eat out frequently? If yes, how many times per week? *

Please answer this question

Physical Activity

How active are you?

Movement is a key part of heart health. Let's see where you're at.

How would you describe your current activity level? *

Sedentary Lightly active Moderately active Very active

Please select your activity level

What types of exercise do you currently do? *

Please answer this question

How many minutes per week do you engage in moderate to vigorous physical activity? *

Please answer this question

Are there any physical limitations or injuries that affect your ability to exercise? *

Please answer this question

What prevents you from being more active? *

Please answer this question

What is your occupation, and does it involve sitting most of the day? *

Please answer this question

Lifestyle & Wellbeing

Nearly there! A few more details about your lifestyle

How would you rate your current stress level? *

Low Moderate High Very high

Please select your stress level

How would you rate your sleep quality? *

Poor Fair Good Excellent

Please select your sleep quality

How many hours of sleep do you get per night on average? *

Please answer this question

Do you smoke or use tobacco products? If yes, how much? *

Please answer this question

Final Details

Last few questions — you're almost done!

Age, height, current weight, and goal weight (if applicable)

What questions do you have about improving your heart health? *

Please answer this question

Is there anything else you'd like our nutritionist to know? *

Please answer this question

I understand this plan is for educational purposes and does not replace medical advice from my physician *

You must agree to continue

Thank you!

Your answers have been submitted successfully.

Our nutritionist will review your responses and you'll receive your personalised health report via email shortly.

If you have any questions, please contact us at info@nfsupplements.co.uk

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