How many hours of sleep do you average per night?
Less than 5 hours
5 to 6 hours
6 to 7 hours
7 to 8 hours
More than 8 hours
How would you rate the quality of your sleep?
1
2
3
4
5
6
7
8
9
10
1 — LOW HIGH — 10
Do you wake up feeling rested most mornings?
Almost never
Occasionally
About half the time
Most mornings, yes
Do you have a consistent wind-down routine before bed?
No routine at all
I try but it is inconsistent
Yes, most nights
Yes, every night without fail
How would you rate your daily stress level?
1
2
3
4
5
6
7
8
9
10
When you are under pressure, do you feel in control or reactive?
Mostly reactive. I am putting out fires.
It depends on the day
Mostly in control with occasional spikes
In control. I have systems for this.
How often do you feel irritable or short-tempered without a clear reason?
Daily
Several times a week
Occasionally
Rarely
Do you have a daily practice for managing stress?
Nothing structured
I exercise but nothing else intentional
I have something but it is not daily
Yes, a consistent daily practice
How would you rate your daily energy level?
1
2
3
4
5
6
7
8
9
10
How often do you move your body intentionally each week?
Rarely or never
1 to 2 times per week
3 to 4 times per week
5 or more times per week
Do you experience unexplained fatigue, soreness, or brain fog?
Yes, most days
Frequently
Occasionally
Rarely or never
Have you had bloodwork done in the last 12 months?
No
Yes but I never reviewed it in detail
Yes and I reviewed it with a provider
Yes and I actively track my biomarkers
How clear are you on your top priorities right now?
Not clear at all. Everything feels equally urgent.
Somewhat clear but I get pulled in too many directions
Pretty clear with occasional drift
Crystal clear. I know exactly what matters.
How often do you feel focused and productive throughout the day?
Rarely. I am scattered most of the time.
I have a good hour or two then lose it
Most of the day with some dips
Consistently focused and productive
Do you feel like you are performing at your potential?
Not even close
Maybe at 50 to 60 percent
Getting there, 70 to 80 percent
Yes, most of the time
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