Hyperspeed Health Solutions | Health Risk Assessment Question Title * 1. 1.Name Question Title * 2. Email Question Title * 3. Phone Number Question Title * 4. Age Question Title * 5. Gender Question Title * 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 Question Title * 7. On a scale of 1-10, how would you rate your fitness level? 1-2 3-5 6-8 9-10 Question Title * 8. On a scale of 1-10, how would you rate your mental wellbeing? 1-2 3-5 6-8 9-10 Question Title * 9. How many times per week do you exercise or do some form of physical activity? 0 1-2 3-5 6-8 9-10 10+ Question Title * 10. On a scale of 1-10, How would you rate the intensity of your workouts? 1-2 3-5 6-8 9-10 Question Title * 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) Question Title * 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 Question Title * 13. Do you suffer from any medical illnesses or conditions (asthma, cancer, diabetes, etc.) No Yes (please specify) Question Title * 14. Does any disease or illness run through your family? No Yes, specify here Question Title * 15. Do you suffer from any pain or nagging injuries No Yes, please mention Please specify here Question Title * 16. Would you consider your day to day workload manageable? Never Rarely Sometimes Often Almost always Question Title * 17. Do you struggle balancing work with your personal life? Never Rarely Sometimes Often Almost always Question Title * 18. On average how many hours do you sleep per night? 1-3 3-5 5-7 7-9 9+ Question Title * 19. Do you typically eat a healthy and balanced daily diet? Never Rarely Sometimes Often Almost always Question Title * 20. Do you drink alcohol? Never Rarely Sometimes Often Almost always Question Title * 21. Do you Smoke? (Cigarettes, vaporized smoke pens, marijuana, etc.) Never Rarely Sometimes Often Almost always Question Title * 22. Do you suffer from anxiety? Never Rarely Sometimes Often Almost always Question Title * 23. How satisfied are you with the conditions of your day to day life ? Very satisfied Satisfied Indifferent Unsatisfied Very unsatisfied Question Title * 24. Are you currently working with a coach or healthcare professional for your health and wellness concerns? Yes No Question Title * 25. Are you open to incorporating technology and in your health and wellness improvement journey? Yes No If you’re willing to share why or why not, please do here Done