Vitamin Quiz - Skin Body Health

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BOTOX APPOINTMENT

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- Skin Care
  - Injectables
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  - PRP (non-surgical facelift)
  - View All Offered Services
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  - Body Sculpting
    - Radio Frequency Body Sculpting
  - Hand Rejuvenation
  - Laser Hair Removal
  - Leg Vein Therapy
  - PRP
    - Hair Restoration
    - Oh LaLa! Shot (for women)
  - View All Offered Services
- Just For Him
  - Facial Rejuvenation
    - BROtox – Male Botox
    - Laser Facial Resurfacing
  - Testosterone Replacement
  - Laser Hair Removal
  - Erectile Dysfunction PRP
  - Hair Restoration PRP
  - View All Offered Services
- Health & Anti-Aging
  - DNA Testing for Weight Loss
  - Hormone Replacement
    - Hormone Rx
  - View All Offered Services
Videos
Blog
Quiz
- Vitamin Quiz
- Skin Quiz
AFFILIATES
Contact
BOTOX APPOINTMENT

Home
About
Shop
Services
- Skin Care
  - Injectables
  - Laser & Chemical Therapy
  - PRP (non-surgical facelift)
  - View All Offered Services
- Body Care
  - Body Sculpting
    - Radio Frequency Body Sculpting
  - Hand Rejuvenation
  - Laser Hair Removal
  - Leg Vein Therapy
  - PRP
    - Hair Restoration
    - Oh LaLa! Shot (for women)
  - View All Offered Services
- Just For Him
  - Facial Rejuvenation
    - BROtox – Male Botox
    - Laser Facial Resurfacing
  - Testosterone Replacement
  - Laser Hair Removal
  - Erectile Dysfunction PRP
  - Hair Restoration PRP
  - View All Offered Services
- Health & Anti-Aging
  - DNA Testing for Weight Loss
  - Hormone Replacement
    - Hormone Rx
  - View All Offered Services
Videos
Blog
Quiz
- Vitamin Quiz
- Skin Quiz
AFFILIATES
Contact
BOTOX APPOINTMENT

Step 1 of 11

9%

Which is your age group?*
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older

Are you*
- Female
- Male
- Prefer not to answer

What are you most concerned about and/or would like to improve?*
- Sexual health
- Weight
- Heart health
- Gut health
- Mental health
- Sleep issues
- Skin, hair, and or nail health
- Energy levels
- General Wellness/Health

In an average month, how often do you drink?*
- Most days of the week
- A few times a week
- Once a week
- None

What concerns you about your weight?*
- I want to slim down (lose 5-15lbs)
- I want to lose a lot of weight (15lbs +)
- I have diabetes-related weight issues
- I want to control my cravings
What concerns you about your heart?*
- I have high cholesterol
- I have high blood pressure
- I have a family history of cardiovascular disease
- I want to maintain a healthy heart
What concerns you about your gut health?*
- Consistent upset stomach
- Consistent acid reflux
- Loose bowel movements
- Infrequent bowel movements
- Feeling bloated
- I notice swelling in my hands, feet, and or face
Which issues are you experiencing with your sleep?*
- Trouble falling asleep
- Trouble staying asleep
- Poor quality of sleep
- Waking up with low energy levels
Have you been diagnosed with thyroid issues?*
- Yes, I have been diagnosed with hypothyroidism
- No, I have never been diagnosed with thyroid issues?
What concerns you about your health?*
- I feel like I get sick often
- I want a more well rounded in my nutritional intake
- I don’t eat enough fruit and vegetables
- I want to slow the aging process
- I often have joint pain and swelling in my extremities

I usually crave*
- Sugary & sweet foods
- Salty & savory foods
- Portion controlled healthy foods
- All of the above

How often do you eat unhealthy or highly processed food (TV dinners, fried food)?*
- Most days of the week
- A few times a week
- Once a week
- Never

How often do you find yourself getting sick?*
- Most months of the year
- A few times a year
- Once a year
- Never

How often do you work out usually?*
- Every day
- Multiple times a week
- Once a week
- Rarely
- Never

How would you rate your diet?*
- I feel like I eat an adequate amount of fruits and vegetables
- I eat fruits and vegetables but I would like a more well-rounded diet
- I eat some fruits and vegetables
- I don’t eat fruits and vegetables

What issues are you currently experiencing with your sexual health?*
- Decreased libido
- Mood swings
- Vaginal dryness or irritation often
- Decreased energy
- Hot flashes or night sweats
What issues are you currently experiencing with your sexual health?*
- Decreased libido
- Mood swings
- Erectile Dysfunction
- Decreased stamina or energy
- Decrease muscle mass
Do you feel like you don’t have as much energy as you used to?*
- Yes
- No
How often do you eat fast food and or highly processed food (ie. junk food)?*
- Every day
- Multiple times a week
- Every couple of weeks
- Rarely
- Never
How often do you exercise?*
- Every day
- Multiple times a week
- Multiple times a month
- Once in a blue moon
- Never
What concerns you about your mental health?*
- I have trouble concentrating
- I have trouble remembering things or events
- I would like to improve memory/cognitive ability
- I struggle with depression
- I struggle with anxiety
- I get easily stressed out
What concerns you about your skin, hair, or nail health?*
- I have acne and would like to clear up my skin
- I am dealing with hair loss, brittle/cracking nails, or would like to enhance hair and nail sheen
- I would like to maintain or improve the appearance & health of my skin
- I would like to reduce crows feet, wrinkles, and other signs of aging skin
What concerns you about your energy levels?*
- My energy levels are consistently low
- I have trouble maintaining energy
- Nothing concerns me about my energy levels

Dr. Burkenstock’s SKIN • BODY • HEALTH is the South’s hallmark Anti-Aging Institute.

FDA Disclaimer
“These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.”

Our Locations

Lakeview, New Orleans Location

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Mandeville Location

2040 N Causeway Blvd,
Mandeville, LA 70471

Hours of Operation

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Mon, Wed: 8:30 am – 4 pm
Tues: 8:30 am – 5 pm
Thurs: 9 am – 1 pm
Fri: 8:30 am – 2 pm

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Sophisticated Women – 2016

Gambit (The Advocate) – 2015

Sophisticated Women – 2013

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