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Onboarding Questionnaire
Tell us more about you!
Here we're getting to know basic information that will help us build a baseline for your journey.
Next question
1.
What is your name?
2.
What is your email address?
3.
How old are you?
Under 25
25-34
35-44
45-54
55-64
Over 65
4.
What is your sex?
Male
Female
Prefer not to answer
5.
What is your height? (in cm.)
6.
What is your weight? (in kg.)
7.
Do you have any children?
Yes
No
If yes, how many?
8.
Do you currently smoke?
Yes
No
Sometimes
I quit
9.
How often do you drink alcohol?
Never
Occasionally (1-3 drinks per month)
Weekly (1-3 drinks per week)
Daily (1+ drinks per day)
Other (please specify)
10.
How many hours do you sleep each night?
4 or fewer hours
About 5-6 hours
About 7-8 hours
9 or more hours
11.
How would you describe your stress level?
Low
Moderate
High
Unmanageable
12.
On average, how many days per week do you engage in at least 30 minutes of physical activity?
0
1 - 2
3 - 4
5+
Other (please specify)
13.
What types of physical activity do you do? (select all that apply)
Walking
Strength training
Cardio (swim, bike, run)
Team sports
Yoga, pilates, or stretching
I don't exercise
Other (please specify)
14.
How would you describe your energy levels throughout the day?
Consistently hight
Balanced with highs and lows depending on the situation
Consistently low
Other (please specify)
15.
Have you ever been diagnosed with any of the following conditions? (select all that apply)
Pre-diabetes
Type 1 diabetes
Type 2 diabetes
Obesity
High blood pressure (hypertension)
High cholesterol (hyperlipidemia)
Gout
Heart disease
Stroke or TIA (mini stroke)
Kidney disease
Liver disease (including fatty liver)
Thyroid disease (e.g Hashimoto's)
Anemia
Polycystic Ovary Syndrome (Females only)
Cancer
Auto-immune disorders
Chronic lung disease (asthma, COPD)
Chronic gastro-intestinal disease (Crohn's, Ulcerative Colitis, etc...)
Depression and/or anxiety
Sleep apnea
None of the above
Other metabolic disorders (please specify)
16.
Has anyone in your family (first degree) ever been diagnosed with any of the following conditions? (select all that apply)
Pre-diabetes
Type 1 diabetes
Type 2 diabetes
Obesity
High blood pressure (hypertension)
High cholesterol (hyperlipidemia)
Gout
Heart disease
Stroke or TIA (mini stroke)
Kidney disease
Liver disease (including fatty liver)
Thyroid disease (e.g Hashimoto's)
Anemia
Polycystic Ovary Syndrome (Females only)
Cancer
Auto-immune disorders
Chronic lung disease (asthma, COPD)
Chronic gastro-intestinal disease (Crohn's, Ulcerative Colitis, etc...)
Depression and/or anxiety
Sleep apnea
None of the above
Other metabolic disorders (please specify)
17.
Are you currently taking any medications?
Yes
No
If yes, please list them
18.
Are you currently taking any supplements regularly?
Yes
No
If yes please list them
19.
How often do you go to the doctor for a check-up or health concerns?
Rarely (only when sick)
Once every few years
About once a year
More than once a year
Other (please specify)
20.
Do you usually get an annual physical exam with blood work?
Yes, every year
Yes, but not every year
No, rarely
Never
Other (please specify)
21.
What area do you feel like you need help with the most? (select all that apply)
Reverse my prediabetes
Manage my diabetes
Lose weight
Eat better
Lead a healthier life
Other (please specify)
Current Progress,
0 of 54 answered
