Your unique journey to well-being begins with us!

Don’t settle for a one-size-fits-all supplement routine! Share a glimpse of who you are with us, including diet and lifestyle, by completing this quick questionnaire. Don’t settle for a one-size-fits-all supplement routine! Share a glimpse of who you are with us, including diet and lifestyle, by completing this quick questionnaire in just 5 minutes or less. Then you'll receive a customized plan tailored to your needs!

Acknowledgement

At Esbamax we recognize that there are medical conditions that go beyond the scope of our health assessment's capabilities. Please select "I accept" below to acknowledge that you do not currently suffer from chronic illnesses like cancer, kidney disease, metabolic disease, IBS/IBD or any other major medical conditions that are under the care of your primary physician.

I accept *

To better understand your preferences for supplement intake and customize your nutritional plan accordingly, please select the option that resonates with you the most: *

I prefer a minimalistic approach with targeted supplements tailored to my specific needs.
I am seeking supplements primarily for overall well-being.
I would like a comprehensive coverage of supplements tailored to address both my needs.

Are you okay with capsule supplements? *

I am fine with capsules
I am fine with capsules, but don’t prefer them if I have other options (i.e. liquid, powder, etc)
I do not like/tolerate capsules

What email can we send your personalized plan to? Your information is stored securely, in line with our terms & conditions and privacy policy *

What was your Sex at Birth? (We ask since this can affect nutritional requirements) *

Male
Female
Non-binary
Other
Do Not Wish to Answer

What is your age? (We ask since this can affect nutritional requirements) *

What is your height? (We ask since this can affect nutritional requirements) *

What is your weight? (We ask since this can affect nutritional requirements) *

What are your dietary preferences? (Select all that apply)

Vegan
Vegetarian
Omnivore
Carnivore
Kosher
No Restrictions

Do you have any allergies or sensitivities to the following? (select all that apply)

Dairy
Fish/Shellfish
Gelatin
Egg
Corn
Soy
Wheat
Gluten
Nuts/Peanuts
Nothing I know of

What is your current Level of Physical Activity? *

Sedentary
Moderately Active
Very Active
Athlete

Are you currently taking any supplements? *

what are they for?

Athletic Performance
Bones, Muscles, and/or Joints
Cognition & Brain Health
Energy & Stress
Digestive Health
Hair, Skin & Nails
Hormone & Sexual Health
Immunity
Migraines & Headaches
Sleep
Other

If you’re not already taking supplements, check which areas you need most support (select all that apply)

Athletic Performance
Bones, Muscles, and/or Joints
Cognition & Brain Health
Energy & Stress
Digestive Health
Hair, Skin & Nails
Hormone & Sexual Health
Immunity
Migraines & Headaches
Sleep
Other

All done!

Congratulations! Your input is invaluable in tailoring our recommendations to your needs. Thank you for taking the time to share more about yourself. You will get the recommendations in your email in 24-48 business hours.

All done!

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