Personal Details

First Name *

Last Name *

Sex *

Male

Female

Age Bracket *

25 - 35

36 - 45

45 - 60

60 +

How often do you exercise for 30 minutes or more? *

Every Day

4-6 times per week

1-3 times per week

I'll let you know when I do

What type of exercise do you mostly do? *

Cardio (running, swimming etc)

Weight training

Yoga / Pilates (or similar)

Walking (with or without the dog)

Describe your sleep patterns *

I get lots of good sleep and get to sleep quickly

I take a while to get to sleep and wake during the night

I don't sleep for long at all and can't get back to sleep

I just want to keep sleeping and sleeping zzzzzzzz

How are your energy levels usually? *

My energy levels are great - when's the next marathon

I have a tired spot about 2-3pm

I always feel a bit tired

Physically I feel fine but mentally I feel exhausted

Mentally I feel fine but physically I feel exhausted

How would you describe your diet? *

I only eat healthy food

80-90% of what I eat is healthy

I was doing well but then was led into temptation

Netflix, chocolate and doritos are awesome

How much water do you typically drink in a day? *

I drink if I feel like it

I drink 1 - 2 litres per day

I drink 3 - 4 litres per day

Does it count if I have it in coffee

How often do you get out into early morning sun on purpose? *

Everyday

Most mornings

When I’m on holidays

What does this “early morning” mean

How often do you go outside and walk on the grass/sand barefoot? *

Daily

Weekly

When I play with the kids

I’m not a hippie!

How would you describe your gut health? *

Excellent - no known issues

Pretty good - occasional issues but eating better now

Have a few issues

Gut health - you can have a healthy gut?

How would you describe your overall outlook on life? *

Happy and optimistic - bring it on

I enjoy life most of the time

Not sure - life seems pretty hard most of the time

I’ve had enough. Surely life should not be this hard - beam me up Scotty

Do you deal with any mental health issues (well we all do to some degree)? *

I’m all good (as good as can be)

Occasionally things overwhelm me

I struggle with people and situations regularly

I’m in bed right now and I don’t want to answer your question

Do you currently have a solid vision for the next 5 years of your life? *

Clear, written, and planned daily

Yep I know what I want, I wrote it somewhere. I’ll get there.

I think I know what I want. Don’t know if it will happen though.

5 years? I don’t know what I’m having for lunch!

How stressed are you generally - overall? *

Stressed - what’s that?

I do get stressed but not regularly.

I’m pretty stressed fairly often

Stress? I thought this was normal life

How would you rate your productivity? *

I’m all over it, I do 16 hours work every 3 hours.

I’m pretty focused most of the time and feel pretty good.

Definitely need help in this area.

I find it hard to find my diary.

Your Contact Information

Email *

City

State