1 of 10
What’s motivating you to improve your health?
I would like to get into better shape
My weight has been impacting my health
To set a better example for my family
I want to feel better mentally, emotionally, and physically
Other
please select an option
2 of 10
What are your weight-related goals?
I would like to lose weight
I would like to gain weight
I don’t have any. I’m happy with the weight I am
please select an option
2(B) of 10
Have you tried losing weight before?
Nope, never.
Once or twice, but nothing seems to stick.
Are you kidding? So many times,I’ve tried everything.
please select an option
3 of 10
Are you currently dealing with any of these health challenges?
Select all that apply. Highlight the
i
for more information.
Digestive health issues
Irritable Bowel Syndrome IBS, Inflammatory Bowel Disease IBD (Crohn's Disease), Inflammatory Bowel Disease IBD (Ulcerative Colitis), Gastric Reflux (Heartburn/ GERD)
Skin health issues
Acne, Psoriasis, Eczema, Rosacea (redness), Xerosis (dry skin), Acanthosis (black skin Patches)
Blood pressure issues
Hypertension
Insulin related issues
Prediabetes, Type 2 Diabetes, Gestational Diabetes, PCOS, Gout
Cholesterol related issues
High LDL cholesterol, Low HDL cholesterol, High Triglycerides
Kidney stones
Mental health issues
Anxiety, Depression, Apathy, Memory loss, Brain fog, Eating disorder
Chronic pain
Rheumatoid Arthritis, Osteoarthritis, Fibromyalgia, Migraines
Sleep issues
Sleep apnea, Insomnia, Disturbed sleep, Fatigue
Thyroid issues
Hypothyroidism (Hashimotos Disease), Hyperthyroidism (Graves Disease)
Non alcoholic fatty liver disease
None of the above
please select at least 1 option
3(A) of 10
What treatment are you currently taking for your digestive health problems?
Over the counter medication
Prescription medication
No medication
please select at least 1 option
3(B) of 10
Do you use medication for your skin condition/s?
Yes, prescription medication
Yes, prescription gels/ointments/lotions
Yes, over-the-counter medication
Yes, over-the-counter gels/ointments/lotions
No prescription
please select at least 1 option
3(C) of 10
What treatment are you currently taking for your mental health issues?
Over the counter medication
Prescription medication
No medication
please select at least 1 option
3(D) of 10
What treatment are you currently taking for your sleep issues?
Over the counter medication
Prescription medication
No medication
please select at least 1 option
4 of 10
Please confirm your birthdate so we can determine your eligibility for the program
5 of 10
Please confirm your height and weight so we can determine your BMI and eligibility for the program
6 of 10
What is your biological sex?
Male
Female
Other
Prefer Not to Say
please select an option
7 of 10
Please specify your ethnicity/race. This helps us to deeply personalize your care in the program.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Other / Non-specified
Prefer Not to Say
please select at least 1 option
8 of 10
Do you have a bluetooth scale to weigh yourself at least once a week?
Yes
No
please select an option
8(A) of 10
Great! How would you like to add your weight to the Digbi Health app?
Manually enter my weight
Allow Apple Health to share weight data from the scale
please select an option
8(B) of 10
Would you like to receive a Digbi-compatible Bluetooth scale to automatically record your weight (at zero cost to you, paid for by your employer)?
Yes, please
No, thanks
please select an option
9 of 10
Please provide your contact information so our care team is able to connect with you and support you on your Health journey.
10 of 10
Lastly, you’re one step away from unlocking your testing kits! Kindly let us know your address so we know where to send them.
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