2. How old are you?

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3. What is your primary health goal?

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4. Would you prefer a health professional who is a:

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5. How would you rate your current physical health?

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6. How would you rate your current eating habits?

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7. Trouble falling asleep, staying asleep, or sleeping too much.

Over the past 2 weeks, how often has this bothered you?

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8. Poor appetite or overeating.

Over the past 2 weeks, how often has this bothered you?

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9. Are you currently experiencing any chronic pain?

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10. What additional resources would be useful for you?

Select all that apply.

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11. How do you prefer to communicate with your health professional?

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12. Preferred appointment times:

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13. Are there any specific preferences for a health professional?

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14. Who referred you to Biohackers United?

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15. Which state are you in?

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