Fit Med NY
This 5-minute assessment will evaluate your diet, lifestyle, and medications to create a personalized vitamin plan tailored just for you.
MaleFemalePrefer not to say
We'll use your email address to save your progress if you need to complete the assessment later, and to send you your personalized vitamin plan when you complete the assessment.
You can opt out of email communication from us at any time.
NoI am pregnantI am trying to become pregnant or am currently breastfeeding
Why we ask... This is important information that helps us determine if you should first connect with your healthcare professional.
YesNo
Got it! Leave QuestionnaireI do not have a kidney or liver condition. Continue Questionnaire
None of theseImmunityMoodStressHair, Skin, & NailsLibidoMemory and FocusSleepBones and JointsEnergyMenopauseDigestionFitnessHeartHealthy AgingWeight controlPMS
Why we ask... We will tailor your recommendations to your dietary preferences.
NoPaleoPescatarianVeganVegetarianKetogenicPlant-Based
Why we ask... One serving of fresh fruit is equivalent to one apple or 8 strawberries. One serving of vegetables is equivalent to a handful of broccoli.
0 to 2 servings3 to 5 servings6 or more servings
Why we ask... One serving of calcium rich foods is equivalent to a fistful of spinach, one cup of milk, 3 to 4 cubes of cheese, or a handful of almonds.
0 to 2 servings3 to 4 servings5 or more servings
Why we ask... One serving of omega-3 fatty acid-rich fish, such as salmon, tuna, cod, or sardines, is three ounces, or around the size of your palm.
0 to 1 serving2 to 3 servingsMore than 3 servings
None of theseMagnesiumVitamin B-12Vitamin D
Why we ask... Chronic alcohol consumption may affect the health of your liver.
NeverSometimesMost Days
Why we ask... Your vitamin requirements may vary if you smoke tobacco.
Why we ask... We have products that may help to support a healthy weight in combination with diet and physical activity
Why we ask... Certain supplements can help address the nutrient gaps, energy slumps and mood changes you may experience during intermittent fasting, as well as help control hunger and cravings.
Why we ask... We offer supplements to help you get the most out of your exercise routine, fight fatigue, and support muscle strength and recovery.
I never or rarely exerciseI occasionally exercise and/or would like to increase my workoutsI exercise regularlyI am in great shape and I work out all the timeI am an athlete or competitor
Why we ask... The right nutrients, in the right amounts, are essential for healthy hair, skin and nails.
No thanksThinning hairFine linesDry SkinSigns of agingGeneral hair, skin, and nail health
NoPsoriasisChronic cold soresEczema
Why we ask... A normal menstrual cycle is typically between 21 to 35 days, and lasts between 2 to 7 days.
Yes, my menstrual cycle is regularNo, my menstrual cycle is irregularThis does not apply to me
NoI experience PMS and/or crampsI commonly experience UTIsI have symptoms related to menopause
None of theseEndometriosisOvulation DisordersUterine FibroidsLow Libido
Why we ask... Family history is an important indicator of your future health.
NoOvarian CancerColon Cancer
Why we ask... Nutrition can affect your state of mind. Understanding your mood and baseline stress level helps us tailor your personal blend.
Generally goodI would like to improve my moodI often feel stressed
Why we ask... Cognitive decline is common as we age, but your nutrition can make a difference!
All goodI sometimes lose focusI can be a little forgetful
Why we ask... We offer natural energy boosters to help power you through your day.
I have no complaintsI usually have an energy slumpI am always exhausted
Why we ask... Your body and mind needs 6.5 to 8.5 hours of sleep every night. Our Sound Slumber Program helps support a more restful sleep.
I get 6.5 to 8.5 hours of sleepI wake up during the nightI have menopausal hot flashesI have trouble falling asleepI wish I slept more soundly
Why we ask... Your health history provides valuable information to customize your daily pack according to your needs.
NoVertigoFibromyalgiaAge-related cognitive declineMigraine headaches
NoSinusitisMacular DegenerationGingivitisGlaucomaCataracts
NoChronic Obstructive Pulmonary Disease (COPD)AsthmaEmphysema
NoHigh TriglyceridesHigh CholesterolAngina and/or AtherosclerosisHigh Blood PressureCongestive Heart Failure
NoOsteoarthritisTendinitisOsteoporosisRheumatoid Arthritis
Why we ask... The right nutrients feed the good guys in your gut, which can promote digestive comfort.
NoAcid Reflux or HeartburnFrequent antibiotic useConstipationIndigestionDiarrheaBloating
NoHyperthyroidismAdrenal fatigue symptomsDiabetic NeuropathyDiabetic RetinopathyHigh Blood Sugar or Type I/II Diabetes
NoI am interested in healthy agingI have had or currently have cancerFrequent colds or viral infectionsI am interested in general immune healthChronic Fatigue SyndromeSeasonal allergies
