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  2. 2013
  3. November
  4. D
  5. Detox
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What is your name (first,last) and gender?
 
Female
 
Male
 
Other
 
 
 
 
What is your marital status?
 
Single (Never married)
 
Married
 
Domestic partnership
 
Widowed
 
Divorced
 
Separated
 
Don’t know
 
 
 
What is your age?
 
Younger than 18
 
18 - 24
 
25 - 34
 
35 - 44
 
45 - 54
 
55 - 64
 
65 or older
 
Prefer not to answer
 
 
 
What types of cleanses you tried in the past (Select all that apply)?
 
Master cleanse (lemon, water, syrup, pepper)
 
Juice cleanse (any straight juice cleanse)
 
Detox program (herbal supplements or other supplements)
 
Other
 

 
 
 
How happy are you with your health as it relates to your nutrition?
 
Needs Improvement
 
Struggling
 
Happy
 
Ecstatic
 
 
 
How happy are you with your health as it relates to your ability to handle stress?
 
Needs Improvement
 
Disappointed
 
Happy
 
Ecstatic
 
 
 
How happy are you with your health as it relates to rest and rejunivation?
 
Needs Improvement
 
Disappointed
 
Happy
 
Ecstatic
 
 
 
How happy are you with your health as it relates to movement and exercise?
 
Needs Improvement
 
Disappointed
 
Satisfied
 
Ecstatic
 
 
 
Do you believe you could benefit from a lifestyle coach? Someone to help you in the areas of nutrition, exercise, stress relief and recovery/rejuvenation?
 
Yes, Definitely
 
Yes, Maybe
 
It Depends
 
No
 
Other
 
 
 
 
Which method of coaching would you prefer (Select all that apply)?
 
One-on-One
 
Group coaching (conference calls, webinars, etc.)
 
Accountability Partner
 
Online Community
 
Other