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Diet

How many times do you eat out a week?

0 – 2
3 – 5
6 – 10
10+

How often do you eat breakfast?

Daily
4-6 days/wk
2-4 days/wk
0-2 days/wk

What percentage of the food you consume is organic?

100%
75%
50%
25%
0%

Do you regularly consume foods that contain: High fructose corn syrup?

No
Yes

Do you regularly consume foods that contain: Gluten?

No
Yes

Do you regularly consume foods that contain: Artificial Sweeteners

No
Yes

Do you regularly consume foods that contain: Dairy?

No
Yes

Do you regularly consume foods that contain: Soy?

No
Yes

Do you snack in between meals?

Yes
No

How often do you feel bloated or gassy after a meal?

Hardly Ever
25% of the time
Half the time
Always

How often do you have a bowel movement?

3+ times/day
1-2x/day
3-5x/wk
1-3x/wk

What percentage of the food that you eat is vegetable based?

100%
75%
50%
25%
Hardly any

How many cups of water do you drink a day?

12+
8 – 11
4 – 7
1 – 3
None

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Exercise

How often do you exercise?

Daily
4-6x/wk
2-4x/wk
Once a week
Never

How often do you stretch?

Daily
4-6x/wk
2-4x/wk
Once a week
Never

How often do you go hiking or walking outdoors?

Daily
4-6x/wk
2-4x/wk
Once a week
Never

How many pullups can you do in a row?

10+
5 to 9
3 to 4
1 to 3
None

Do you eat within an hour of working out?

Always
Usually
Not usually
Never

How much aerobic exercise are you getting in your workouts

30+ minutes
15-30 minutes
up to 15 minutes
none

What percentage of your workouts include strength training?

100
75
50
25
None

Do you have injuries that prevent you from exercising as you’d like?

Nope
They don’t stop me
Yeah
Big time

Do you focus mostly on the “Beach Muscles” when you train?

I’m all functional training
They are part of a balanced program
Mostly
Yup-Looks are everything

Do you get up and stretch during the day if you’ve been sitting?

I get up every 20-30 minutes
Maybe once an hour or two
Once or twice a day
I’m glued to my desk

Are you more than 20 pounds overweight?

No
Yes

Any major accidents that have impaired your ability to exercise/move around?

No
Yes

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Mindset

Do you wake up with enthusiasm in the morning?

Almost Always
Often
Occasionally
Seldom
Never really…

Are you happy with your career?

Yes
It’s ok but can be better
It’s ok
Not really
I hate my job

Do you have a healthy family life?

Absolutely
Pretty good
It’s whatever…
We fight and have problems
Its really bad at home

How often do you feel depressed?

Hardly ever
On occasion with good cause
Here and there each month
At least once a week
A few times a week or more

Do you set goals for your personal growth?

All the time
Yes but I flake on them here and there
Yes but I never follow through
Not really

Where would you rank your average STRESS levels on a scale of 10 (worst)

1-3 (Not really too stressed)
4-6 (Its certainly part of my life)
7-8 (It impacts my life often)
9-10 (It is debilitating at times)

Do you have a religious or spiritual practice that is fullfilling?

Yes
Kind of…
No

Do you take time for mental health time-outs?

Yes- I schedule them
Yes when I know I’m overdue
Yes- when I’ve hit rock bottom
Time out? The show must go on!

Do you read books or listen to lectures for personal growth?

Yes
Once in a while
I don’t have time for that stuff

How much do money problems or debt weigh on your mind?

I’m good
I’ve got it but it doesn’t bother me much
On my mind most of the time
I’m really suffering from it

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Sleep

What’s the average amount of sleep you get each night?

More than 8 hours
5-7 Hours
2-4 Hours
Less than 2 hours

How long does it take for you to fall asleep on average each night?

Less than 15 min
15-30 minutes
30-60 minutes
Over an hour

How often do you wake up in the middle of the night?

Hardly ever
1-2 times
3-4 times
More than 4 times

How often do you wake up refreshed and ready to start your day?

Most mornings
3-4 times per week
Once a week
Hardly ever

Do you wake up with an appetite?

I’m hungry in the mornings and can chow
I can eat but not much
I grab a coffee and biscuit for the car
I am not hungry at all in the mornings

Do you take naps or little “time-out” breaks during the day

Yes- I do so regularly
Once in a while when I can get it
When I need it
Who’s got time for that?

Do you watch TV in bed?

No way
Once in a while
Often
Every night

Seasonally, do you slow down and do less/rest more in the winter?

I do and it helps
Occasionally
Rest? I’ve got holiday shopping to do

How many nights a week do you drink alcohol?

I usually don’t drink
1 to 2
3-4
5-7

How often do you take caffeine AFTER 2pm?

Never
1-2 days/week
2-5 days/week
6-7 Day/week
Finally, give us your name and email address and we’ll email you your Well.org Vitality Score
along with suggestions and resources on how to improve it. IMPORTANT: Make sure to use a consistent email each time you take the survey so you can compare all results.
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