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Personal Blend Self-Evaluation Tool
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Personal Blend Re-order
+65 9889 6942
(Mon-Fri excluding Public Holidays 9am-6pm)
hello@biogmicrotabs.sg
Personal Blend Self-Evaluation
Date/Time
20 Jun 2019, 11:35 PM
Personal Info
01.
Is this your first time using this tool?
Yes
No
My previous BioG™ Personal Blend ID is
*
If you do not know your BioG™ Personal Blend ID, please enter your birthdate and contact no.
Date of Birth
*
Contact No.
*
Looking up your previous BioG™ Personal Blend Formula ensures an accurate review of your new nutritional needs.
02.
Are you recommended by an authorised BioG™ Practitioner?
Yes
My BioG™ Practitioner ID is
*
No
Others (Core Collective)
Would you like to submitting DNA/Blood test to us?
*
Without DNA/Blood test submission:
$65
With DNA/Blood test submission:
$85
03.
To ensure an accurate Personal Blend Formulation, please tell us about yourself.
Surname
*
Name
*
Race/ Ethnicity
Email
*
Contact No
*
Gender
*
Male
Female
Date of Birth
*
Height (m)
*
Weight (kg)
*
Body Mass Index
Note: A BMI value of 23 and above indicates that your weight is out of the healthy range for your height. Source: Health Promotion Board, www.hpb.gov.sg
Family Medical History:
If you are currently taking health supplements or traditional herbs, pls provide details:
* Indicates required field. Your date of birth and contact no. are required to ensure that the correct Personal Blend Formula is delivered to you.
04.
Delivery Option
This is not a confirmation to purchase. Entering your option now makes it more convenient for you if you decide to make a purchase.
Have it delivered
Address
*
Postal Code
*
Timeslot
*
- Select -
Before 12 noon
12pm to 5pm
5pm to 8pm
05.
If you have a promo code, enter it here:
By participating in this Self-Evaluation Tool, I agree to allow BioG™ and its agent/representative to contact me regarding my BioG™ Personal Blend and related matters.
Your personal particulars and all information entered on this Self-Evaluation Tool are strictly private and confidential.
Please refer to our
Privacy Policy
for details.
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This Self-Evaluation takes about 5-10 minutes to complete.
Answers are not saved if you do not complete the full self-evaluation and click "Submit".
