Hyperspeed Health Solutions | Health Risk Assessment

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* 1. Name

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* 2. Email

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* 3. Phone Number

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* 4. Age

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* 5. Gender

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* 6. What are your health & wellness goals? Check all that apply.

Increase productivity and overall performance day to day

Improve overall well-being and quality of life

Prevent the onset of chronic diseases like heart disease, diabetes, and cancer/reduce the risk of illness or injury

Manage an existing health condition or disease

Increase energy levels and decrease fatigue

Improve mental health and reduce stress

Improve physical appearance and body image

Improve mobility and flexibility

Manage weight and body composition

Reduce dependence on medication or medical interventions

Improve brain function and cognitive performance

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* 7. On a scale of 1-10, how would you rate your fitness level?

1-2

3-5

6-8

9-10

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* 8. On a scale of 1-10, how would you rate your mental wellbeing?

1-2

3-5

6-8

9-10

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* 9. How many times per week do you exercise or do some form of physical activity?

1-2

3-5

6-8

9-10

10+

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* 10. On a scale of 1-10, How would you rate the intensity of your workouts?

1-2

3-5

6-8

9-10

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* 11. What type of physical activity do you participate in?

Swimming

Running

Pilates

HIIT

Weight Lifting

Biking

Yoga

Stretching

Recreational Sports (basketball, baseball, football, frisbee, etc)

Other (please specify)

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* 12. Define your athletic background

No athletic background

Played sports growing up

Played in highschool (14-18)

Played in college (19-24)

Played Sports Professionally

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* 13. Do you suffer from any medical illnesses or conditions (asthma, cancer, diabetes, etc.)

Yes (please specify)

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* 14. Does any disease or illness run through your family?

Yes, specify here

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* 15. Do you suffer from any pain or nagging injuries

Yes, please mention

Please specify here

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* 16. Would you consider your day to day workload manageable?

Never

Rarely

Sometimes

Often

Almost always

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* 17. Do you struggle balancing work with your personal life?

Never

Rarely

Sometimes

Often

Almost always

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* 18. On average how many hours do you sleep per night?

1-3

3-5

5-7

7-9

9-11

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* 19. Do you typically eat a healthy and balanced daily diet?

Never

Rarely

Sometimes

Often

Almost always

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* 20. Do you drink alcohol?

Never

Rarely

Sometimes

Often

Almost always

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* 21. Do you Smoke? (Cigarettes, vaporized smoke pens, marijuana, etc.)

Never

Rarely

Sometimes

Often

Almost always

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* 22. Do you suffer from anxiety?

Never

Rarely

Sometimes

Often

Almost always

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* 23. How satisfied are you with the conditions of your day to day life ?

Very satisfied

Satisfied

Indifferent

Unsatisfied

Very unsatisfied

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* 24. Are you currently working with a coach or healthcare professional for your health and wellness concerns?

Yes

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* 25. Are you open to incorporating technology and AI in your health and wellness improvement journey?

Yes

If you’re willing to share why or why not, please do here