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Secret Diet Online Survey

HyungInJae's Secret Diet Program is a 1:1 personalized Diet program.online questionnaire for a face-to-face prescription.

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  • 7 steps · about 10 minutes
  • Multiple answers allowed

HyungInJae’s Secret Diet Program is a 1:1 personalized Diet program.
online questionnaire for a face-to-face prescription.

The same content as in-person surveys used in clinics,
You can check all questions multiple times.
If you don’t see a description that fits your condition
please feel free to write in the ‘other’ box for each question.

Please fill in the form without any blanks!

  1. 1basic information
  2. 2digestion-defecation-sleep
  3. 3edema – menstrual – pain – fatigue
  4. 4medical history – medications – exercise
  5. 5weight – Diet experience
  6. 6Goals – Diet
  7. 7meals-snacks-drinks-drinks-drinks-coffee

1basic information

Please tell us your gender.*
Please tell us if you plan to get pregnant (birth control is mandatory during the Diet).
How did you hear about HyungInJae Korean Medicine Clinic?*

Submitting opens an email with your answers filled in.

By appointment · 1:1 care by the chief director

After the survey, the chief director reviews it and contacts you

196 m from Gangnam Stn. Exit 4 · Weekdays 10–19 · Sat & holidays 10–17

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