Plant-based Transformation Survey: Before

This quick survey will let us track your health habits on your path to freedom and fitness. If you don't track these yet, put your best estimate. DON'T BE DISCOURAGED! It's only a pre-survey.

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* 1. In the last 30 days, I mostly felt (from 1 to 10)

Awful (1)

Average

Amazing! (10)

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 2. In a typical week, how many days do you

	0	1	2	3	4	5	6	7
exercise for at least 30 minutes (light sweat or more)?	exercise for at least 30 minutes (light sweat or more)? 0	exercise for at least 30 minutes (light sweat or more)? 1	exercise for at least 30 minutes (light sweat or more)? 2	exercise for at least 30 minutes (light sweat or more)? 3	exercise for at least 30 minutes (light sweat or more)? 4	exercise for at least 30 minutes (light sweat or more)? 5	exercise for at least 30 minutes (light sweat or more)? 6	exercise for at least 30 minutes (light sweat or more)? 7
eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball)	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 0	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 1	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 2	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 3	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 4	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 5	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 6	eat at least 3 servings of fruits and vegetables? (One serving is about the size of a tennis ball) 7
eat fried food?	eat fried food? 0	eat fried food? 1	eat fried food? 2	eat fried food? 3	eat fried food? 4	eat fried food? 5	eat fried food? 6	eat fried food? 7
eat desserts high in added sugar?	eat desserts high in added sugar? 0	eat desserts high in added sugar? 1	eat desserts high in added sugar? 2	eat desserts high in added sugar? 3	eat desserts high in added sugar? 4	eat desserts high in added sugar? 5	eat desserts high in added sugar? 6	eat desserts high in added sugar? 7
use books, podcasts, or meditation to grow personally and professionally?	use books, podcasts, or meditation to grow personally and professionally? 0	use books, podcasts, or meditation to grow personally and professionally? 1	use books, podcasts, or meditation to grow personally and professionally? 2	use books, podcasts, or meditation to grow personally and professionally? 3	use books, podcasts, or meditation to grow personally and professionally? 4	use books, podcasts, or meditation to grow personally and professionally? 5	use books, podcasts, or meditation to grow personally and professionally? 6	use books, podcasts, or meditation to grow personally and professionally? 7

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* 3. In a typical week, how many days do you drink

	0	1	2	3	4	5	6	7
half your bodyweight in ounces of water?	half your bodyweight in ounces of water? 0	half your bodyweight in ounces of water? 1	half your bodyweight in ounces of water? 2	half your bodyweight in ounces of water? 3	half your bodyweight in ounces of water? 4	half your bodyweight in ounces of water? 5	half your bodyweight in ounces of water? 6	half your bodyweight in ounces of water? 7
more than 2 alcohol drinks?	more than 2 alcohol drinks? 0	more than 2 alcohol drinks? 1	more than 2 alcohol drinks? 2	more than 2 alcohol drinks? 3	more than 2 alcohol drinks? 4	more than 2 alcohol drinks? 5	more than 2 alcohol drinks? 6	more than 2 alcohol drinks? 7
1 or more sugar sweetened beverages?	1 or more sugar sweetened beverages? 0	1 or more sugar sweetened beverages? 1	1 or more sugar sweetened beverages? 2	1 or more sugar sweetened beverages? 3	1 or more sugar sweetened beverages? 4	1 or more sugar sweetened beverages? 5	1 or more sugar sweetened beverages? 6	1 or more sugar sweetened beverages? 7

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* 4. In the last 30 days, I'd rate my quality of sleep (from 1 to 10)

Awful (1)

Average

Amazing! (10)

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 5. Please answer the following:

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I usually set, strive for, and achieve reasonable goals for myself	I usually set, strive for, and achieve reasonable goals for myself Strongly Disagree	I usually set, strive for, and achieve reasonable goals for myself Disagree	I usually set, strive for, and achieve reasonable goals for myself Neither Agree nor Disagree	I usually set, strive for, and achieve reasonable goals for myself Agree	I usually set, strive for, and achieve reasonable goals for myself Strongly Agree
I feel confident	I feel confident Strongly Disagree	I feel confident Disagree	I feel confident Neither Agree nor Disagree	I feel confident Agree	I feel confident Strongly Agree
I maintain my relationships and behaviors in ways that are healthy for myself and others	I maintain my relationships and behaviors in ways that are healthy for myself and others Strongly Disagree	I maintain my relationships and behaviors in ways that are healthy for myself and others Disagree	I maintain my relationships and behaviors in ways that are healthy for myself and others Neither Agree nor Disagree	I maintain my relationships and behaviors in ways that are healthy for myself and others Agree	I maintain my relationships and behaviors in ways that are healthy for myself and others Strongly Agree
I take the health benefits of physical activity and their lasting impact seriously	I take the health benefits of physical activity and their lasting impact seriously Strongly Disagree	I take the health benefits of physical activity and their lasting impact seriously Disagree	I take the health benefits of physical activity and their lasting impact seriously Neither Agree nor Disagree	I take the health benefits of physical activity and their lasting impact seriously Agree	I take the health benefits of physical activity and their lasting impact seriously Strongly Agree

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* 6. Work-life balance

	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I enjoy my work	I enjoy my work Strongly Disagree	I enjoy my work Disagree	I enjoy my work Neither Agree nor Disagree	I enjoy my work Agree	I enjoy my work Strongly Agree
I am satisfied with the balance between my work time and leisure time	I am satisfied with the balance between my work time and leisure time Strongly Disagree	I am satisfied with the balance between my work time and leisure time Disagree	I am satisfied with the balance between my work time and leisure time Neither Agree nor Disagree	I am satisfied with the balance between my work time and leisure time Agree	I am satisfied with the balance between my work time and leisure time Strongly Agree
I am satisfied with my ability to manage and control my work load	I am satisfied with my ability to manage and control my work load Strongly Disagree	I am satisfied with my ability to manage and control my work load Disagree	I am satisfied with my ability to manage and control my work load Neither Agree nor Disagree	I am satisfied with my ability to manage and control my work load Agree	I am satisfied with my ability to manage and control my work load Strongly Agree
I manage the level of stress in my work environment	I manage the level of stress in my work environment Strongly Disagree	I manage the level of stress in my work environment Disagree	I manage the level of stress in my work environment Neither Agree nor Disagree	I manage the level of stress in my work environment Agree	I manage the level of stress in my work environment Strongly Agree
My work usually contributes to and is part of a productive and fulfilling life	My work usually contributes to and is part of a productive and fulfilling life Strongly Disagree	My work usually contributes to and is part of a productive and fulfilling life Disagree	My work usually contributes to and is part of a productive and fulfilling life Neither Agree nor Disagree	My work usually contributes to and is part of a productive and fulfilling life Agree	My work usually contributes to and is part of a productive and fulfilling life Strongly Agree

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* 7. Waist measurement to the nearest half inch (belly button level, don't guess)

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* 8. What do you most want to improve during this program? It doesn't have to be from this survey.

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* 9. What's your contact info (optional, but helps with follow up)

First and Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address