• Skin
  • Gut
  • iconsjiva Mind
  • Body
  • Soul
  • Your Jivome

1. Most of the time my skin is


2. Which of the following do you currently experience on your face or body? (Select all that apply)

3. Do any of the following bother you on your face or body? (Select all that apply)

4. Which of the following is closest to your skin color?

Turn your palm towards you and look at the color of the skin on your inner forearm

5. Have you noticed any of the following about your scalp or hair?
(Select all that apply)

6. Do any of the following bother you about your nails?
(Select all that apply)

7. In terms of your digestion, which of the following do you usually experience? (Select all that apply)

8. How often do you experience heartburn?

9. How much stress do you feel on an average day?

10. How much anxiety do you feel on an average day?

11. How well is your focus and concentration on a typical day?

12. How quickly do you become irritated or angry?

13. How many hours do you typically sleep per night?

14. How rested do you usually feel after an average night’s sleep?

15. How quickly do you become mentally or physically tired?

16. What are your main fitness goals? (Select all that apply)

17. How do you typically make important decisions?

18. How quickly do you bounce back from setbacks and failures?

19. Finally, tell us what you find important in your life. Please mark the three that are the most important factors to you?