Health & Wellness Survey Form

Thank you for taking the time to complete this survey.

Your Details

Name

Email Address

Age

Gender

Male

Female

Country

Health and Wellness

What are your goals? (Choose your top 3)

Specify any micro goals you have (e.g do a pull up)

What is keeping you from achieving your goals? (Check all that apply)

Lack of Motivation

Hitting a Plateau

Money

Time

Self-conscious

Lack of Results

Lack of Equipment

Not Knowing Where/How to Begin

Other

What motivates you? (Check all that apply)

Seeing Results

Accountability

Having Fun

Feeling Better

Praise/Rewards

Other

What activities/exercises do you currently do? (Check all that apply)

How often do you workout?

Once a week

2-3 times a week

More than 2-3 times a week

Once every two weeks

Less than once every two weeks

Never

Rate your CURRENT health & wellness (1 = bad, 10 = excellent)

How SERIOUS are you in achieving your goals? (1 = not serious at all, 10 = extremely serious)

Survey has been completed. Have a good day!