Get Busy Living8 Initial Questionnaire
What am I missing? What do I want? How do I get there?
2/2 2018 *
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Cathie Sage *
Your answer
7/18/1962
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PO Box 194, Peterborough, NH 03458
Your answer
Your answer
How would you describe how you feel about your: *
Content
Needs work
Unhappy
Fitness
Relationship(s)
Energy level
Overall health
Food choices
Stress level
Emotional health
Spiritual health
Body image
Activity level
How would you describe how you feel about your: *
Content
Needs work
Unhappy
Fitness
Relationship(s)
Energy level
Overall health
Food choices
Stress level
Emotional health
Spiritual health
Body image
Activity level
When you experience obstacles or difficulties in your life you tend to: *
Yes
No
Work through or around them and move forward
Get derailed or discouraged and give up
Procrastinate but eventually get the job done
I don't set goals, it is too much pressure
Take to social media and vent to anyone who will listen
Keep my struggles to my self and manage it the best I can
Do any of the following apply to you? *
Yes
No
High stress level or feelings of despair in any aspect of your life (job, relationship, family, etc.)
I "eat out" more than three times per week.
I often have feelings of anger, envy and/or jealousy
I am a smoker or use tobacco
I have a physical hobby or am physically active at least three times per week
I occasionally or often meditate, pray or engage in positive self talk
I am generally "happy" most days of the week
I feel pressure or bullying from peers or someone else about the way I look
I feel presure or bullying from peres or someone else about what I believe
I have a problem with my blood pressure or a family history of high blood pressure
I feel my body fat is at an unhealthy level
I often have a very dfifficult time waking up from sleep
I frequently get 7 to 9 hours of sleep at night
I generally have a positive attitude
I typically do what I want regardless of how others around me feel
I am very concerned about what others think of me
I sometimes feel I need to "compete" with my peers
I have many or a few very close friends
I have a method for "deflating" after a busy or intense day or situation
I struggle with managing my busy schedule, sometimes to the point of tears
Do you struggle with your eating habits? *
Yes
No
I can't find the time to prepare food at home
I or my family do not like to try new foods or I am a picky eater
I often feel tired and eat what is fast and available
Others in my household often eat or request "junk food"
Healthier foods tend to be too expensive
I always feel rushed when grocery shopping and stick to the same items to save time
I can't be bothered to think about my diet
I take my children grocery shopping with me
I have teens in my house!
I am an "emotional" eater
I am generally aware of what I eat but there is so much confusion, I don't know if I am making the right choices
Do you experience gastrointestinal problems? *
Yes
No
Occassionally
Diarrhea
Excess gas
Excess mucus or blood in stool
Cramping
Severe constipation
Do you struggle with physical activity *
Yes
No
Can't find the time
I hate to sweat
I feel too tired
I don't like to be around other people
Too expensive
I have trouble establishing goals
Working out embarrasses me
It just doesn't feel good to work out or I lack motivation
I have an injury
I don't know what to wear when I work out
I don't struggle, I feel healthy and strong
Do you have a membership to a fitness or weight loss facility? *
Yes
No
I am a member of a fitness facility
I have a membership but do not use it
Are you under the care of a healthcare professional that has given you recommendations or orders to make lifestyle changes or are you on medication(s)? *
Yes
No
I have orders and I am working toward making recommended changes
I have orders but could use motivation to follow through
I would pay for help with implementing orders from my healthcare professional
I have not seen a healthcare professional in more than 2 years
I am recovering from an injury or other issue
Would coaching assistance in any of the following areas be valuable for you or your family? *
Yes, but am not willing or can't afford to pay for it
No
Yes, I am willing to pay for this service
Nutrition/food choices
Fitness/feel strong
Stress reduction
Emotional/positive reinforcement
Lifestyle advice
In-home intervention (food choices or preparation, in home workouts, hoarding, social isolation, other)
How would you prefer to communicate? *
Required
If you have any questions please contact:
Carol Leger at getbusyliving8@gmail.com or you may leave your comments below
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