MB VITALITY NEXUS
  • Mission
  • Founder
  • Programs/Classes
    • MB Vitality Group Program
    • Customized Programs
    • Coherent Breathing Sessions
    • Live Yin Yoga Classes Via Zoom >
      • Yin Yoga Resources
  • Client Love
  • MB Loves
    • Wellness Technology
    • Breathe/Meditate >
      • BrainTap
      • Oxygen Therapy
    • Nourish >
      • MB Nutrition Plan
      • MB Essential Supplements
      • Grab n' Go
      • Comfort
      • DIY - Easy Recipes
      • Eat Out/Order In - NYC
      • Hydrate/Water Purification
      • Farmers Markets
    • Move >
      • Fitness & Wellness Equipment & Technology
      • Online & Studio Classes
      • Yin with Magen
      • Suit Up / Oraganic Sustainable Fashion
    • Learn >
      • Apps
      • Books
      • Films/TV Shows
      • Music
      • Podcasts
      • Videos
    • Nest >
      • Purify Your Air >
        • Indoor Air Expert
      • Protect from EMF/EMR
      • Purify Your Water
      • Sleep >
        • BrainTap
      • Decorate/Design Sustainably
    • Clean Beauty >
      • Self Care
      • Beauty Experts
      • Nail Care
    • Travel >
      • Hotels & Resorts
    • Cancer / Chronic Disease
    • Experts
    • Fur Fairies (Pets)
  • Connect

    Health History Q&A

    Do you now, or have you in the past had:
    Please elaborate on yes answers in the comments box at the end of this section. 

    Weight/fitness history

    Diet and Exercise History

    If you have participated in an Optimal Mind Body program or retreat, please list:    

    Please rate the below responses on a scale of 1-10. 1 being poorest, 10 being best. 
    How do you feel:

    Sleep

    Elimination:
    Frequency 1=1 x a week, 2=2 week, 3=3x week,  7 = 1x day, etc.


    Btw-I know these questions may be difficult and gross but they give me a lot of information about the health of your gut and digestion and therefore your overall health.
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    Please list your intentions/goals below:

    Exercise

    What activities do you most enjoy/dislike the least:
    ​
    Put a Y next to those you like the most and an N to those you like the least

    Exercise schedule and availability :
    During your Optimal Mind Body Program, what are the optimal days and time(s) of day for you to work out?
    Please list the time of day and maximum amount of time you have per day (if any) to devote to a workout (s):   

    Lifestyle

    Thank you for filling out my Health Q & A form. 
    You are one step closer to living your Optimal Mind Body life!
     XOMB

Submit

​HIPAA Compliance
. To the extent required by the provisions of the Health Insurance Portability and Accountability Act (HIPAA) and the regulations promulgated thereunder, the parties hereby agree to appropriately safeguard protected health information (PHI) made available to or obtained by either of them pursuant to this Agreement. Without limiting the obligations of either party otherwise set forth in this Agreement or imposed by applicable law, each party agrees to comply with applicable requirements of law relating to PHI and with respect to any task or other activity it performs in connection with this Agreement.

CONNECT WITH MAGEN

WORK WITH MAGEN 
Registration is now open for Q2
MB Vitality Membership
Click here for program information 
   
YIN YOGA WITH MAGEN VIA ZOOM 

Click here for Yin Yoga class information 

MAGENS LOVES 
Explore Magen's nutrition plan, recipes, fave tech and other curated healthy lifestyle resources. 
Click here for Magen's LOVES. 
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  • Mission
  • Founder
  • Programs/Classes
    • MB Vitality Group Program
    • Customized Programs
    • Coherent Breathing Sessions
    • Live Yin Yoga Classes Via Zoom >
      • Yin Yoga Resources
  • Client Love
  • MB Loves
    • Wellness Technology
    • Breathe/Meditate >
      • BrainTap
      • Oxygen Therapy
    • Nourish >
      • MB Nutrition Plan
      • MB Essential Supplements
      • Grab n' Go
      • Comfort
      • DIY - Easy Recipes
      • Eat Out/Order In - NYC
      • Hydrate/Water Purification
      • Farmers Markets
    • Move >
      • Fitness & Wellness Equipment & Technology
      • Online & Studio Classes
      • Yin with Magen
      • Suit Up / Oraganic Sustainable Fashion
    • Learn >
      • Apps
      • Books
      • Films/TV Shows
      • Music
      • Podcasts
      • Videos
    • Nest >
      • Purify Your Air >
        • Indoor Air Expert
      • Protect from EMF/EMR
      • Purify Your Water
      • Sleep >
        • BrainTap
      • Decorate/Design Sustainably
    • Clean Beauty >
      • Self Care
      • Beauty Experts
      • Nail Care
    • Travel >
      • Hotels & Resorts
    • Cancer / Chronic Disease
    • Experts
    • Fur Fairies (Pets)
  • Connect