LIFESTYLE QUESTIONNAIRE
How old are you?
18-29
30-39
40-49
50-59
60-69
70-79
80+
Do you already wear an activity tracker or smart watch?
Yes - Fitbit
Yes - Apple Watch
Yes - Another Product
No
Do you smoke or vape?
Yes, I smoke
Yes, I vape
No, but I used to smoke
No, but I used to vape
I have never smoked or vaped
How often do you currently participate in some kind of exercise?
Three or more times per week
Once or twice per week
A few times per month
Not at all
Does your occupation involve much physical activity (e.g. standing, lifting, walking, etc.)?
Yes
No
How frequently would you say you suffer from stress?
Never
Occasionally
Very Often
All The Time
How would you describe your style of diet?
Vegan
Vegetarian
Pescatarian
Omnivore
Would you say your current eating habits give you a good overall quality of nutrition?
Yes
No
Not Sure
Would you say the amount of food you typically eat every day is...
About Right For Your Needs
Less Than You Need
More Than You Need
How would you rate your general day-to-day energy level?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your general day-to-day mood?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your current overall level of fitness?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your current stamina level?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your current strength level?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your current level of flexibility?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your level of knowledge about nutrition in general?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your level of knowledge about plant-based nutrition?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
How would you rate your level of knowledge about veganism?
1 (very low)
2
3
4
5 (average)
6
7
8
9
10 (very high)
Pulse check... What is 3 x 12?
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