Bio-Hacker Tracker Quiz (A Self-Assessment Survey)

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This survey will help you discover areas of your life that need improvement, prioritize the most important problem, monitor your progress and (after adjustments have been made and the primary problem improved) we can use this data to reveal the next problem you'd like to improvement.

Email *

Last name, first name *

My energy level is usually

Excellent long lasting energy all day long without coffee, drugs, or prescriptions 10

Very good/get a lot done without coffee, energy drinks or stimulating meds (8)

Good but need coffee, energy drinks or medication with a stimulating effect or for ADD (6)

Fair I can't do as much as I should or as much as others my age (4)

Poor-I can’t even get the basics done without dragging (0 point)

Other:

Clear selection

My Mood, Motivation & Happiness is

Excellent, happy almost all of the time (+10 points)

Very good, happy most of the time (+8 pts)

Good, happy just over half of the time (+6 pts)

Fair, happy less than half of the time (+4 pts)

Poor, rarely happy (0 pts)

Clear selection

My memory Retention, Mental Clarity, Concentration & Focus is

Excellent, without drugs or medications for Attention Deficit Disorder (+10 points)

Very Good, I remember most things & can focus almost all of the time without meds (+8 pts)

Good without meds(+6 pts)

Fair, most of the time, I can’t focus or am forgetful (+4 pts)

Poor or only good with medication (0 pts)

Clear selection

My stress & ability to cop are

Excellent, I handle stress exceptionally well without sudden outbursts of anger, anxiety or frustration (10 points)

Very Good (+8 pts)

Good (+ 6 pts)

Fair, I have difficulties coping with every day situations at home and/or work more than 3 days per week (+ 4 pts)

Poor, They are a daily struggle or I suddenly get angered, mad or sad out of proportion to most people's reaction (0 pts)

Clear selection

My gut health, nausea, acid reflux, abdominal pain/cramps, constipation, or diarrhea

don't exist. I have none of those symptoms. (+10 points)

rarely occur, usually less than 1 occurrence in 6-12 months (+ 8 pts)

occur less than monthly (+ 6 pts)

occur at least once per week (+ 4 pts)

occurs most days/week (0 pts)

Clear selection

My current weight is *

Ideal for me, totally content, within normal BMI (Body Mass Index aka weight for my hei) and the acceptable norm (+10 points)

Although I'm within normal BMI, I have less than 5 lbs I'd like to lose (+8pts)

My BMI is 30-35, aka overweight (+6 pts)

My BMI is 35-40, aka obese (+4 pts)

My BMI is over 40, aka morbid (0 pts)

Other:

Rashes, stuffy or runny nose, asthmatic attack or wheezing occur

Once in past few years (+ 10 points)

rarely, once in past year (+ 8 pts)

about twice in past year (+ 6 pts)

at least 4 time per year or once per season (+ 4 pts)

occurs most days/week (0 pts)

Clear selection

On a pain scale of 1-10 with 10 being the worst pain I've ever had, my pain level is usually

no pain (+10 points)

no pain most of the time or only mild, infrequent pain that doesn’t hold me back (+8 pts)

mild pain (4 or less on a pain scale 1-10 with 10 being the worst pain) less than 7 days week per month and still able to do everything I enjoy (+ 6 pts)

5 out of 10 pain or more at least 2 days per month, or pain prevents me from doing ann activity(+ 4 pts)

pain the majority of days and it prevents me form doing activities (0 points)

Clear selection

My sleep QUALITY is

Excellent-I awaken well rested most days per month without any medication (+10 points)

Very good-I awaken well rested most of the time but may need a sleep aid, medication or drinks for energy (+ 8 pts)

Good (+ 6 pts) I sleep so-so

Fair (+ 4 pts) often awaken tired and/or awaken multiple times or have sleep apnea

Poor (0 pts)

Clear selection

My hair thinning, brittle nails, wrinkles and bones are

Excellent, look younger than my age & have a thick head of hair , bones and strong nails (+ 10 points)

Very good (+ 8 pts) compared to those of a similar age

Good (+ 6 pts) look my age but my hair is frizzy or my nails are brittle

Fair (+ 4 pts) look older than most my age

Poor, look older than I am, have hair thinning, brittle nails, osteopenia or osteoporosis (0 points)

Clear selection

Considering health problems that may make me sad or mad (i.e., like rashes, pain, wheezing, abdominal cramps, IBS, fatigue, brain fog or hair thinning), the number of medications, including over the counter and energy drinks I use and how many symptoms I still have that hold me back from more joy, my overall quality of life and well-being are

Excellent, no symptoms i.e., fatigue stop me from doing what I want (+ 10 points)

Very good, I'm on none or 1 medication & typically visit a doctor or healthcare facility once per 3 months or less (+8 pts)

Good (+ 6 pts)

Fair i.e. I'm on multiple medications, or still have symptoms or typically have more than 1 visit to a doctor or healthcare facility per month (+ 4 pts)

Poor I'm worse than all above options i.e. on many medications or have multiple doctor visits per month (0 points)

Clear selection

I learn best *

from combination of visual, audio, printed material, Q&As and 1 on 1 consultations

watching and listening

llstening to audios

google search teaches me all I ever need

I don't want to learn anything

Please feel free to add any additional symptoms that bother you, diagnoses, abnormal test results, or recommendations to improve this form.

A copy of your responses will be emailed to the address you provided.

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