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metaBRAIN Study - Submission Form
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Name
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Your answer
Please provide your preferred mailing address.
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Your answer
Will you be able to take metaBRAIN according to the instructions and take each week’s assessment to the best of your ability?
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Yes
No
Do you have a daily supplementation routine?
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Yes
No
Do you feel like there are some aspects in your life (i.e. energy, work performance, etc) that can be improved?
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Your answer
What healthy habits do you practice (i.e. journaling or meditation). List a maximum of five.
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Your answer
How many days do you workout per week (including all physical activity such as hiking)?
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1-2 Days
3-4 Days
5-6 Days
7 Days
None
Do you live a lifestyle that requires peak performance, or work in a high-stress environment?
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Yes
No
Do you currently take any other supplements? If so, what are they?
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Your answer
How much do you weigh (in lbs)?
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Your answer
How many cups of coffee do you typically drink per day? If you take any supplements with caffeine be sure to include that amount as well.
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Example answer: 2 cups of coffee with 100 mg pre-workout per day
Your answer
A copy of your responses will be emailed to the address you provided.
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