Survey

1) How many servings of vegetables do you get a day?

None
1-2 servings
3-4 servings
5-6 servings
7 or more servings

2) How many hours of sleep do you get each night?

Less than 5 hours
5-7 hours
7-8 hours
8-9 hours
More than 9 hours

3) How many hours of exercise do you get in a week?

None
Less than 1 hour
1-3 hours
3-5 hours
More than 5 hours

4) How much do you meditate?

None
Sometimes
1-3 times per week
4-6 times per week
Daily or more

5) How many glasses of water do you drink daily?

None
1-2 glasses
3-4 glasses
5-6 glasses
7 or more glasses

6) How much caffeine do you get daily?

0 mg
50 mg
100 mg
200 mg
400 mg or more

7) How much alcohol do you drink?

None-infrequent
1 drink or less on any given day and 1 or less times a month?
1-2 drinks daily or occasional 3-4 drinks
3 drinks or more daily or infrequent binge drinking
More than 8 drinks/week

8) Rate your current effort to live according to your values/faith.

1
2
3
4
5

9) Rate the current effort you are putting into your relationships.

1
2
3
4
5

10) How much do you smoke or use tobacco products?

Excesively
Regularly
Occasionally
Rarely
Never

11) How much do you vape?

Excessively
Regularly
Occasionally
Rarely
Never

12) How much do you use recreational marijuana?

Excessively
Regularly
Occasionally
Rarely
Never

13) How much processed food including fast food, packaged food and snacks do you eat?

None
Seldom
Regularly
Moderately
A lot