Training Questionnaire
Email address *
Name *
Phone *
City, State where you live *
Date of Birth *
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What neurological condition do you have? *
How long have you had this condition? *
What is your commitment to yourself? What do you hope to get from a weekend workshop with REACT coaches? *
What guides the decisions you make about exercise? *
How would you best describe your exercise routine? (check all that apply) *
Required
What is your primary obstacle to exercising on a regular basis?
What do you consider regular basis? *
Is there a style of exercise or specific exercise that you like? Please explain... *
How often do you prioritize movement in an average week? *
How many hours of sleep do you average per night? *
How do you decide what time to go to bed and wake up? *
Do you have trouble falling asleep? *
How would you rate the quality of your sleep? *
Do you wake up feeling rested? *
Does your sleep affect your motivation to achieve your goals? *
What are your biggest stressors? *
In general, do you have emotional support from a significant other, friend, or family member? *
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