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GIVE THE GIFT OF HEALTH

VibraGenix Holiday Special

Your Health Is Your Wealth!

Our Gift To You - 0% financing for three years O.A.C. or Three Easy Payments!

Get a FREE Consultation with Dr. Caroline Stites to learn more before you buy!

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How to Become an Affiliate
VibraGenix Workout #8 – VibraGenix Shoulder Workout with Tru!
VibraGenix Workout #6 – Arm Workout with Tru!

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Recent

How to Become an Affiliate
VibraGenix Workout #8 – VibraGenix Shoulder Workout with Tru!
VibraGenix Workout #6 – Arm Workout with Tru!

These statements have not been evaluated by the FDA, Health Canada or the Public Health Agency of Canada. The use of, the sale of, and the purchase of any products offered by VibraGenix LLC, are not intended for any medical purposes. These products and all products sold by VibraGenix are not intended to diagnose, treat, cure or prevent any disease in man or other animals, and are strictly for health, wellness and exercise purposes only. Any benefits listed on this web site are based on independent studies which reference over 50 years of research into whole body vibration exercise and training. The material provided herein is intended for educational and informational purposes only. We are not engaged in rendering any medical service or advice, and the information provided is not a substitute for a professional medical opinion. If you have a medical problem, please contact your doctor or a qualified health professional.

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Fill out this questionnaire and we will get back to you with suggestions on how to use the VibraGenix for your optimal transformation program!

What following goals best fits in with your goals?*
- Improved health
- Improved endurance
- Increased strength
- Increased muscle mass
- Weight Loss
- Increased flexibility
- Decreased pain and stiffness
- Anti-Aging
- Recovery From Pain and Injury
- Workout Recovery
- Other
Other Goals
What is the activity level at your job or daily routine?
- none (seated only)
- Moderate (light activity such as walking)
- High (heavy labor, very active)
Please list the physical activities that you participate in outside of work.
Pre-Existing Conditions
Do you have any diagnosed health problems?
- No
- Yes
If you have diagnosed health problems, check the condition(s).*
- Diabetes
- Asthma
- high or low blood pressure
- Heart Disease
- Arthritis
- Memory loss
- Brain injury or PTSD
- Balance and Dizziness
- Back pain
- Neck Pain
- Fatigue
- Recent Surgeries
- Pregnancy
- Other
Other Conditions
What additional therapies are being undertaken for the given health problem(s)?
Are you on any medications?
- No
- Yes
Do you have any injuries?
- No
- Yes
Injury Description
What addition therapies are being undertaken for the given injury?
Are you experiencing any stress, anxiety, anger, depression or motivational problems?
- No
- Yes
- Maybe
Are you a current cigarette smoker or vaper?
- No
- Yes
Your current diet could be best characterized as:
- Low-fat
- Low-carb
- high-protein
- Vegetarian/Vegan
- No special diet
- Other
Other Diet
Which of the following activities do you participate in?
- Professional or High level Sports
- Recreational Sports
- Tennis
- Racquetball
- Pickleball
- Weight lifting
- Swimming
- Personal training
- Rock Climbing
- Cycling
- Tennis
- Yoga and pilates
- Physical Therapy
- Towed Water Sports
- Hiking
- Mountain Biking
- Snow Sports
- Fitness Classes
- Other
Other Activities
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Last Name
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Month
Day
Year
Height
Weight in lbs.
Please enter a number from 100 to 500.