This free survey is powered by
0%
Exit Survey
 
 
I fit within the age group of ___
 
10-13
 
14-17
 
18-22
 
23-28
 
29-33
 
34-38
 
39-46
 
47-50
 
51-60
 
61-66
 
67-77
 
78-88
 
89-100+
 
 
 
Most days I feel I have more energy around _____ (select all that apply)
 
12:00 a.m. - 5 a.m. (early morning)
 
6:00 a.m. - 11 a.m. (morning)
 
12:00 p.m. (noon)
 
1:00 p.m. - 3 p.m. (afternoon)
 
4:00 p.m. - 8 p.m. (evening)
 
9:00 p.m. - 11 p.m. (night)
 
Other

 
 
 
Most nights I get about __ hours of sleep (select all that apply)
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10
 
11
 
12
 
Other
 

 
 
 
I am __
 
Male
 
Female
 
Other
 
 
 
Most Days I eat ___ (select all that apply)
 
A healthy breakfast
 
A somewhat healthy breakfast
 
I don't usually eat breakfast
 
A healthy lunch
 
A somewhat healthy lunch
 
I don't usually eat lunch
 
A healthy dinner
 
A somewhat healthy dinner
 
I don't usually eat dinner

 
 
 
I mostly maintain a weight of ___
 
80-90
 
91-100
 
101-110
 
111-120
 
121-130
 
131-140
 
141-150
 
151-160
 
161-170
 
171-180
 
181-190
 
191-200
 
201-210
 
211-220
 
221-230
 
231-240
 
241-250
 
Other
 
 
Share This Survey:          Online Survey Software Powered by  QuestionPro Survey Software