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Are you Burntout, Surviving or Thriving?

Name*
First
Email*
Rest & Recuperation
What time do you typically fall asleep?*
What time do you typically fall asleep?
- Between 10-11pm or earlier
- Between 11pm-12am
- After 12am
How rested do you feel first thing in the morning?*
How rested do you feel first thing in the morning?
- Not at all
- Fairly rested
- Rested and refreshed
Meals and Timing
Do you take the time to eat?*
Do you take the time to eat?
- I tend to rush meals out of habit or squeeze meals in where possible
- I have the right amount of time
- I take as much time as I like and generally eat slowly
How do you typically feel 1-2 hours after eating*
How do you typically feel 1-2 hours after eating
- Tired / Sleepy
- Neutral / Don’t notice
- Energised
Hydration
What type of water do you drink*
What type of water do you drink
- Tap / Plastic Bottled Water
- Glass Bottled Water / Basic Water Filter / Reverse Osmoses
- More Advanced and Thorough Water Filter
How much pure water do you drink per day?*
How much pure water do you drink per day?
- Less than a litre
- 1-2 litres
- 2-3 litres or more
Exercise & Activity Levels
How do you feel about the amount of exercise you do?*
How do you feel about the amount of exercise you do?
- I don't do enough or can't fit it in.
- I'm ok as I manage to squeeze some into my week
- I exercise moderately most days
- I train very intensively/ to total exhaustion 5-7 days a week
How do you feel after exercise?*
How do you feel after exercise?
- Very tired / Exhausted but wired and high
- Neutral / Satisfied
- Good
- Not Applicable
Stress levels
What’s your day to day stress levels?*
What’s your day to day stress levels?
- Never, I don’t notice it
- I feel stressed now and again
- I feel stressed all the time
When are you at your highest stress?*
When are you at your highest stress?
- First thing in the morning
- During day
- End of the day ( evening )
- I don't notice
Mind Set
What do you think about your health and wellbeing?*
What do you think about your health and wellbeing?
- I feel terrible
- I want to improve
- Exactly where I want to be/ or close
Whats statement best describes your day today mood?*
Whats statement best describes your day today mood?
- I feel happy most days
- Neutral, I don’t notice
- I feel quite negative and low most days
Number
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