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  • Your Jivome

1. I would describe my skin as usually

2. I usually experience the following on my face and body (Select all that apply)

3. I am bothered by the following on my skin or body. (Select all that apply)

4. Based on the color of the skin on my inner forearm, my skin closely resembles

5. I have the following issues with my scalp and hair
(Select all that apply)

6. I have the following issues with my nails
(Select all that apply)

7. I usually struggle with the following digestion issues (Select all that apply)

8. I experience heartburn

9. My stress level is usually

10. My anxiety is usually

11. My ability to concentration is usually

12. I normally become frustrated or angry

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13. On a normal night I sleep for

14. After a night of sleep I typically feel

15. I become mentally or physically tired

16. My main fitness goals are (Select all that apply)

17. I typically make important decisions with

18. Normally I bounce back from failures and setbacks

19. The top 3 things that are most important to me in life are

20. The areas where I would like to grow personally are (Select all that apply)

21. My dietary and food preferences are (Select all that apply)