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Gender Identification Male Female
How often do you eat breakfast? Select an option Every day Most days Rarely Never
How many meals do you eat per day? * Select an option 5-6 4 2-3 1
How many servings of fruit do you eat per day? * Select an option 3-4 2 1 Usually none
How many servings of vegetables do you eat per day? * Select an option 8-9 6-7 1 Fewer then 5
How many servings of grains do you eat per day? * Select an option 3 or more 2 1 Fewer then 5 per day 1
How many servings of legumes do you eat per week? * Select an option 5 or more 3-4 1-2 Fewer then 1
How often do you eat foods that contain ingredients like refined sugar, enriched flour and other negative ingredients? * Select an option Almost never 1-2 times per week 3-4 times per week More than 4 times per week
How often do you consume artificial sweeteners? * Select an option Never Occassionally Weekly More than one time per week
How often do you consume fast food? * Select an option Never Occassionally Weekly More than one time per week
How often do you consume soft drinks? * Select an option Never Occassionally Weekly More than one time per week
How often do you consume animal foods (beef, dairy, chicken, eggs, fish, etc)? * * Select an option Never 1-3 times per week 4 or more times per week 5 or more times per week
(If not a vegetarian) How often do you eat organic animal foods and wild caught fish? * Select an option Always Sometimes Never
How often do you consume dairy products? * Select an option Never Weekly Daily More than once per day
How often do you consume 64 ounces of water? * Select an option Daily Most days Rarely Almost never
What type of water do you typically drink? * Select an option Carbon filtered Bottled with minerals (like Evian or Fiji) Tap water Reverse osmosis or distilled
How often do you drink alcohol? * Select an option 1 time per week or none 2 times per week 3 times per week 4 or more times per week
How often do you consume oils (in salad dressings, cooking oils, in packaged foods)? * Select an option Almost never Several times per week Once per day More than once per day
How often do you drink coffee? * Select an option Occassionally Weekly Daily More than one cup per day
What is your smoking history? * Select an option I have never smoked I quit over 5 years ago I quit less than 5 years ago I quit less than 1 year ago I currently smoke
How often do you engage in social activities? * Select an option At least once per week Fewer than once per week Once per month Rarely
What is your relationship status? * Select an option I am happy being single I am happily married I am happy in a committed relationship I am single and unhappy I am married and unhappy I am in a relationship and unhappy
How are your friendships? * Select an option I am happy being single I am happily married I am happy in a committed relationship I am single and unhappy I am married and unhappy I am in a relationship and unhappy
How are your relationships in general? * Select an option Most of my relationships with others are good Some of my relationships need improvement I often have conflicts with other people
How is your job/career? * Select an option I like my job I like only parts of my job I wish I had a different job I wish I had a different career
How is your relationship with yourself? * Select an option I like myself I like some aspects of myself I need to make major improvements in myself I don’t like myself
What is your outlook on life? Part 1 * Select an option I am very optimistic I am usually optimistic I often feel pessimistic I tend to be pessimistic
What is your outlook on life? Part 2 * Select an option I have a good sense of humor I can sometimes laugh at life I have trouble maintaining my sense of humor I generally do not have a good sense of humor
How often do you exercise? * Select an option I work out 5 or more days/week I work out 4 days per week I work out 3 days per week I work out 2 times/week or less
What is the length of each workout? * Select an option My workouts are 45 minutes or longer each My workouts are 30-40 minutes My workouts are 15-25 minutes My workouts are less than 20 minutes
How many minutes do you spend in your target heart zone during each workout? * Select an option 45 minutes or more 30-40 minutes 20-20 minutes Less than 20 minutes
How often do you do weight training? * Select an option 2 or more times per week 1 time per week A couple of times per month Rarely