What are your fitness and health habits?
How much control do you currently have over your eating and activity level?
Email address *
Do you schedule time to be physically active each day? *
Never
Nearly Always
Do you seek out opportunities to move throughout the day (walk, bike, stairs, park farther away)? *
Never
Nearly Always
Does physical activity increase your energy? *
Never
Nearly Always
Does physical activity improve your fitness and health? *
Never
Nearly Always
Do you schedule time to exercise most days of the week? *
Never
Nearly Always
Do you seek professional advice prior to starting an exercise program? *
Never
Nearly Always
Do you seek professional advice prior to starting a new eating routine? *
Never
Nearly Always
Do you make exercise a priority in your day? *
Never
Nearly Always
Do you have a support system who encourages exercise? *
Never
Nearly Always
Do you have a support system who encourages positive eating habits? *
Never
Nearly Always
Does your family support your current activity level? *
Never
Nearly Always
Do you plan social activities to involve physical activity? *
Never
Nearly Always
Do you plan exercise when traveling on vacation or for business? *
Never
Nearly Always
How comfortable are you at know what food is a good healthy choice? *
Never
Nearly Always
How often do you eat when you aren't hungry? *
Never
Nearly Always
How often do you focus on eating with no distractions? *
Never
Nearly Always
How often do you eat fruits and vegetables? *
Never
Nearly Always
How often do you eat meat? *
Never
Nearly Always
How often do you eat fried food? *
Never
Nearly Always
How often do you consume a drink with calories? *
Never
Nearly Always
How aware are you of your day to day food consumption habits? *
Never
Nearly Always
How often do you stop eating before you are "fully satisfied"? *
Never
Nearly Always
Do you plan your meals for the week? *
Never
Nearly Always
Do you plan your meals for the day? *
Never
Nearly Always
How often do you feel fitness and health is a part of your lifestyle? *
Never
Nearly Always
How often do you say you want to get healthy and improve your fitness? *
Never
Nearly Always
How often do you eat at your favorite restaurant? *
Never
Nearly Always
Do you focus on what you eat and how much you eat? *
Never
Nearly Always
How often do you think about how a food, meal, beverage will effect your future health? *
Never
Nearly Always
Do you write down your exercise? *
Never
Nearly Always
Do you write down how you feel? *
Never
Nearly Always
Do you write down what you eat? *
Never
Nearly Always
How often do you like to change? *
Never
Nearly Always
Do you wish you could buy a pill, product or process that will melt away your body? *
Never
Nearly Always
How often do you think about your fitness and health goals? *
Never
Nearly Always
How often do you write down your goals? *
Never
Nearly Always
How often do you feel you are taking steps backward away from your fitness and health goals? *
Never
Nearly Always
How often do you try a new diet, pill or program? *
Never
Nearly Always
How often do you feel you are taking steps backward? *
Never
Nearly Always
How often do you believe you can make a positive exercise routine change? *
Never
Nearly Always
How often do you believe you can make a positive diet change? *
Never
Nearly Always
How often do you believe you can be your own success story? *
Never
Nearly Always
How often do you feel you deserve a more healthy lifestyle? *
Never
Nearly Always
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