Full Name *

Email *

Phone *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Know where you are so you can rise to where God is leading you.” ✝️

Instructions:

Choose the answer that best describes you right now.

1. How often do you check your blood sugar? *

A. Almost never

A few times a week

Daily

Consistently at scheduled times

2. How would you describe your eating pattern? *

A. I eat whatever is convenient

B. I try to choose healthier options sometimes

C. I follow some type of structured eating plan

D. I’m intentional about nourishment + whole foods daily

3. How frequently do you drink juice or soda with sugar? *

A. Daily

B. A few times a week

C. Rarely

D. Never — I avoid added sugars

4. Do you experience symptoms like fatigue, excessive thirst, or frequent urination? *

A. Daily

B. Often

C. Sometimes

D. Rarely or not at all

5. How consistent are you with physical activity or movement? *

A. Not consistent

B. Some days

C. Most days

D. Regularly — I have a rhythm I follow

6. How would you describe your mindset about reversing diabetes? *

A. I don’t believe it’s possible

B. I hope it’s possible but I’m not sure

C. I believe it can happen with support

D. I fully believe healing is possible and I’m committed

7. How often do you cook whole food meals at home? *

A. Rarely

B. A few times a week

C. Most of the time

D. Almost always — I prioritize clean eating

8. How much water do you drink daily? *

A. Less than 40 oz

B. 40–60 oz

C. 60–80 oz

D. 80+ oz consistently

9. How often do you read labels for carbs, sugar, and ingredients? *

A. Never

B. Sometimes

C. Most times

D. Always — I know exactly what to look for

10. How supported do you feel on your health journey? *

A. Not supported at all

B. Some support

C. Mostly supported

D. Very supported — community matters to me