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The 5-10 Minute Age-Defying Health Survey
A mission to measure 500 High-Impact Leaders on their health, optimism and best practices. Most respondents have completed this in 5 -10 minutes. Thank you for participating.
25
Questions
START
1
Rate your current level vs your optimal level in the following areas of Age-Defying Health "ADH"
*
This field is required.
Mindset = Your willingness and ability to take control and responsibility for your health. Sleep = How often are you getting 7-8 hours of high-quality sleep. Nutrition = How often are you taking in food, water and supplements that support your health goals. Exercise = Actions that build muscle, improve flexibility and increase cardio. Technology = Diagnostics, wearables, therapies, biohacking, etc.
Below 25%
Below 50%
Below 75%
Between 75-90%
Between 90-100%
Mindset
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Sleep
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Nutrition
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Technology
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Mindset
Sleep
Nutrition
Exercise
Technology
Below 25%
Row 0, Column 0
Below 50%
Row 0, Column 1
Below 75%
Row 0, Column 2
Between 75-90%
Row 0, Column 3
Between 90-100%
Row 0, Column 4
Below 25%
Row 1, Column 0
Below 50%
Row 1, Column 1
Below 75%
Row 1, Column 2
Between 75-90%
Row 1, Column 3
Between 90-100%
Row 1, Column 4
Below 25%
Row 2, Column 0
Below 50%
Row 2, Column 1
Below 75%
Row 2, Column 2
Between 75-90%
Row 2, Column 3
Between 90-100%
Row 2, Column 4
Below 25%
Row 3, Column 0
Below 50%
Row 3, Column 1
Below 75%
Row 3, Column 2
Between 75-90%
Row 3, Column 3
Between 90-100%
Row 3, Column 4
Below 25%
Row 4, Column 0
Below 50%
Row 4, Column 1
Below 75%
Row 4, Column 2
Between 75-90%
Row 4, Column 3
Between 90-100%
Row 4, Column 4
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2
Rate your current level (1=worst / 10=best) in the following areas of Age-Defying Health
*
This field is required.
Mindset = Your willingness and ability to take control and responsibility for your health. Sleep = How often are you getting 7-8 hours of high-quality sleep. Nutrition = How often are you taking in food, water and supplements that support your health goals. Exercise = Actions that build muscle, improve flexibility and increase cardio. Technology = Diagnostics, wearables, therapies, biohacking, etc.
1
2
3
4
5
6
7
8
9
10
Mindset
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Sleep
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Nutrition
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Technology
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Row 4, Column 8
Row 4, Column 9
Mindset
Sleep
Nutrition
Exercise
Technology
1
Row 0, Column 0
2
Row 0, Column 1
3
Row 0, Column 2
4
Row 0, Column 3
5
Row 0, Column 4
6
Row 0, Column 5
7
Row 0, Column 6
8
Row 0, Column 7
9
Row 0, Column 8
10
Row 0, Column 9
1
Row 1, Column 0
2
Row 1, Column 1
3
Row 1, Column 2
4
Row 1, Column 3
5
Row 1, Column 4
6
Row 1, Column 5
7
Row 1, Column 6
8
Row 1, Column 7
9
Row 1, Column 8
10
Row 1, Column 9
1
Row 2, Column 0
2
Row 2, Column 1
3
Row 2, Column 2
4
Row 2, Column 3
5
Row 2, Column 4
6
Row 2, Column 5
7
Row 2, Column 6
8
Row 2, Column 7
9
Row 2, Column 8
10
Row 2, Column 9
1
Row 3, Column 0
2
Row 3, Column 1
3
Row 3, Column 2
4
Row 3, Column 3
5
Row 3, Column 4
6
Row 3, Column 5
7
Row 3, Column 6
8
Row 3, Column 7
9
Row 3, Column 8
10
Row 3, Column 9
1
Row 4, Column 0
2
Row 4, Column 1
3
Row 4, Column 2
4
Row 4, Column 3
5
Row 4, Column 4
6
Row 4, Column 5
7
Row 4, Column 6
8
Row 4, Column 7
9
Row 4, Column 8
10
Row 4, Column 9
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3
How much have you improved or regressed in the following areas during the last 24 months?
*
This field is required.
Mindset = Your willingness and ability to take control and responsibility for your health. Sleep = How often are you getting 7-8 hours of high-quality sleep. Nutrition = How often are you taking in food, water and supplements that support your health goals. Exercise = Actions that build muscle, improve flexibility and increase cardio. Technology = Diagnostics, wearables, therapies, biohacking, etc.
Major Regression
Somewhat Regressed
No Change
Somewhat Improved
Major Improvement
Mindset
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Sleep
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Nutrition
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Technology
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Mindset
Sleep
Nutrition
Exercise
Technology
Major Regression
Row 0, Column 0
Somewhat Regressed
Row 0, Column 1
No Change
Row 0, Column 2
Somewhat Improved
Row 0, Column 3
Major Improvement
Row 0, Column 4
Major Regression
Row 1, Column 0
Somewhat Regressed
Row 1, Column 1
No Change
Row 1, Column 2
Somewhat Improved
Row 1, Column 3
Major Improvement
Row 1, Column 4
Major Regression
Row 2, Column 0
Somewhat Regressed
Row 2, Column 1
No Change
Row 2, Column 2
Somewhat Improved
Row 2, Column 3
Major Improvement
Row 2, Column 4
Major Regression
Row 3, Column 0
Somewhat Regressed
Row 3, Column 1
No Change
Row 3, Column 2
Somewhat Improved
Row 3, Column 3
Major Improvement
Row 3, Column 4
Major Regression
Row 4, Column 0
Somewhat Regressed
Row 4, Column 1
No Change
Row 4, Column 2
Somewhat Improved
Row 4, Column 3
Major Improvement
Row 4, Column 4
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4
Rate your current level vs your optimal levels in each category?
*
This field is required.
Below 25%
Below 50%
Below 75%
Between 75-90%
Between 90-100%
Capability
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Energy
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Strength
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Resilience
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Athletic Ability
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Feeling of Health
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Capability
Energy
Strength
Resilience
Athletic Ability
Feeling of Health
Below 25%
Row 0, Column 0
Below 50%
Row 0, Column 1
Below 75%
Row 0, Column 2
Between 75-90%
Row 0, Column 3
Between 90-100%
Row 0, Column 4
Below 25%
Row 1, Column 0
Below 50%
Row 1, Column 1
Below 75%
Row 1, Column 2
Between 75-90%
Row 1, Column 3
Between 90-100%
Row 1, Column 4
Below 25%
Row 2, Column 0
Below 50%
Row 2, Column 1
Below 75%
Row 2, Column 2
Between 75-90%
Row 2, Column 3
Between 90-100%
Row 2, Column 4
Below 25%
Row 3, Column 0
Below 50%
Row 3, Column 1
Below 75%
Row 3, Column 2
Between 75-90%
Row 3, Column 3
Between 90-100%
Row 3, Column 4
Below 25%
Row 4, Column 0
Below 50%
Row 4, Column 1
Below 75%
Row 4, Column 2
Between 75-90%
Row 4, Column 3
Between 90-100%
Row 4, Column 4
Below 25%
Row 5, Column 0
Below 50%
Row 5, Column 1
Below 75%
Row 5, Column 2
Between 75-90%
Row 5, Column 3
Between 90-100%
Row 5, Column 4
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5
Rate your current level vs your optimal levels in each category?
*
This field is required.
Below 25%
Below 50%
Below 70%
Between 70-80%
Between 80-90%
Between 90-100%
Capability
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Energy
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Strength
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Resilience
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Athletic Ability
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Feeling of Health
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Capability
Energy
Strength
Resilience
Athletic Ability
Feeling of Health
Below 25%
Row 0, Column 0
Below 50%
Row 0, Column 1
Below 70%
Row 0, Column 2
Between 70-80%
Row 0, Column 3
Between 80-90%
Row 0, Column 4
Between 90-100%
Row 0, Column 5
Below 25%
Row 1, Column 0
Below 50%
Row 1, Column 1
Below 70%
Row 1, Column 2
Between 70-80%
Row 1, Column 3
Between 80-90%
Row 1, Column 4
Between 90-100%
Row 1, Column 5
Below 25%
Row 2, Column 0
Below 50%
Row 2, Column 1
Below 70%
Row 2, Column 2
Between 70-80%
Row 2, Column 3
Between 80-90%
Row 2, Column 4
Between 90-100%
Row 2, Column 5
Below 25%
Row 3, Column 0
Below 50%
Row 3, Column 1
Below 70%
Row 3, Column 2
Between 70-80%
Row 3, Column 3
Between 80-90%
Row 3, Column 4
Between 90-100%
Row 3, Column 5
Below 25%
Row 4, Column 0
Below 50%
Row 4, Column 1
Below 70%
Row 4, Column 2
Between 70-80%
Row 4, Column 3
Between 80-90%
Row 4, Column 4
Between 90-100%
Row 4, Column 5
Below 25%
Row 5, Column 0
Below 50%
Row 5, Column 1
Below 70%
Row 5, Column 2
Between 70-80%
Row 5, Column 3
Between 80-90%
Row 5, Column 4
Between 90-100%
Row 5, Column 5
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6
Rate your levels from 5 years ago vs your optimal levels in each category?
*
This field is required.
Below 25%
Below 50%
Below 75%
Between 75-90%
Between 90-100%
Capability
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Energy
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Strength
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Resilience
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Athletic Ability
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Feeling of Health
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Capability
Energy
Strength
Resilience
Athletic Ability
Feeling of Health
Below 25%
Row 0, Column 0
Below 50%
Row 0, Column 1
Below 75%
Row 0, Column 2
Between 75-90%
Row 0, Column 3
Between 90-100%
Row 0, Column 4
Below 25%
Row 1, Column 0
Below 50%
Row 1, Column 1
Below 75%
Row 1, Column 2
Between 75-90%
Row 1, Column 3
Between 90-100%
Row 1, Column 4
Below 25%
Row 2, Column 0
Below 50%
Row 2, Column 1
Below 75%
Row 2, Column 2
Between 75-90%
Row 2, Column 3
Between 90-100%
Row 2, Column 4
Below 25%
Row 3, Column 0
Below 50%
Row 3, Column 1
Below 75%
Row 3, Column 2
Between 75-90%
Row 3, Column 3
Between 90-100%
Row 3, Column 4
Below 25%
Row 4, Column 0
Below 50%
Row 4, Column 1
Below 75%
Row 4, Column 2
Between 75-90%
Row 4, Column 3
Between 90-100%
Row 4, Column 4
Below 25%
Row 5, Column 0
Below 50%
Row 5, Column 1
Below 75%
Row 5, Column 2
Between 75-90%
Row 5, Column 3
Between 90-100%
Row 5, Column 4
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7
My primary motivation for living a long and healthy life is so that I can.....
*
This field is required.
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8
Lifespan: At what age do you expect to live to?
*
This field is required.
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9
Healthspan: At what maximum age do you expect to maintain at least 80% of your current physical and mental capabilities?
*
This field is required.
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10
How much additional Lifespan + Healthspan do you believe you could achieve with access to better health information, technology and science?
*
This field is required.
5%
15%
25%
35%
45%
75%
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11
Which of the following amounts best represents your Monthly Spend in each category?
*
This field is required.
Mindset = Your willingness to take control and responsibility for your health. Sleep = How often are you getting 7-8 hours of high-quality sleep. Nutrition = How often are you taking in food, water and supplements that support your health goals. Exercise = Actions that build muscle, improve flexibility and increase cardio. Technology = Diagnostics, wearables, therapies, biohacking, etc.
$0
$100
$500
$1000
$3000
$5000
Mindset
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Sleep
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Nutrition
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Technology
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Mindset
Sleep
Nutrition
Exercise
Technology
$0
Row 0, Column 0
$100
Row 0, Column 1
$500
Row 0, Column 2
$1000
Row 0, Column 3
$3000
Row 0, Column 4
$5000
Row 0, Column 5
$0
Row 1, Column 0
$100
Row 1, Column 1
$500
Row 1, Column 2
$1000
Row 1, Column 3
$3000
Row 1, Column 4
$5000
Row 1, Column 5
$0
Row 2, Column 0
$100
Row 2, Column 1
$500
Row 2, Column 2
$1000
Row 2, Column 3
$3000
Row 2, Column 4
$5000
Row 2, Column 5
$0
Row 3, Column 0
$100
Row 3, Column 1
$500
Row 3, Column 2
$1000
Row 3, Column 3
$3000
Row 3, Column 4
$5000
Row 3, Column 5
$0
Row 4, Column 0
$100
Row 4, Column 1
$500
Row 4, Column 2
$1000
Row 4, Column 3
$3000
Row 4, Column 4
$5000
Row 4, Column 5
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12
In the next 24 months, do you estimate spending more or less in the following categories?
*
This field is required.
Mindset = Your willingness to take control and responsibility for your health. Sleep = How often are you getting 7-8 hours of high-quality sleep. Nutrition = How often are you taking in food, water and supplements that support your health goals. Exercise = Actions that build muscle, improve flexibility and increase cardio. Technology = Diagnostics, wearables, therapies, biohacking, etc.
Much Less
Less
The Same
More
Much More
Mindset
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Sleep
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Nutrition
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Technology
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Mindset
Sleep
Nutrition
Exercise
Technology
Much Less
Row 0, Column 0
Less
Row 0, Column 1
The Same
Row 0, Column 2
More
Row 0, Column 3
Much More
Row 0, Column 4
Much Less
Row 1, Column 0
Less
Row 1, Column 1
The Same
Row 1, Column 2
More
Row 1, Column 3
Much More
Row 1, Column 4
Much Less
Row 2, Column 0
Less
Row 2, Column 1
The Same
Row 2, Column 2
More
Row 2, Column 3
Much More
Row 2, Column 4
Much Less
Row 3, Column 0
Less
Row 3, Column 1
The Same
Row 3, Column 2
More
Row 3, Column 3
Much More
Row 3, Column 4
Much Less
Row 4, Column 0
Less
Row 4, Column 1
The Same
Row 4, Column 2
More
Row 4, Column 3
Much More
Row 4, Column 4
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13
Areas of Growth. Rate your excitement below for each category for learning about and/or testing new products and services.
*
This field is required.
Mindset = Your willingness to take control and responsibility for your health. Sleep = How often are you getting 7-8 hours of high-quality sleep. Nutrition = How often are you taking in food, water and supplements that support your health goals. Exercise = Actions that build muscle, improve flexibility and increase cardio. Technology = Diagnostics, wearables, therapies, biohacking, etc.
Not Excited
Somewhat Excited
Very Excited
I need this today!
Mindset
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Sleep
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Nutrition
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Technology
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Mindset
Sleep
Nutrition
Exercise
Technology
Not Excited
Row 0, Column 0
Somewhat Excited
Row 0, Column 1
Very Excited
Row 0, Column 2
I need this today!
Row 0, Column 3
Not Excited
Row 1, Column 0
Somewhat Excited
Row 1, Column 1
Very Excited
Row 1, Column 2
I need this today!
Row 1, Column 3
Not Excited
Row 2, Column 0
Somewhat Excited
Row 2, Column 1
Very Excited
Row 2, Column 2
I need this today!
Row 2, Column 3
Not Excited
Row 3, Column 0
Somewhat Excited
Row 3, Column 1
Very Excited
Row 3, Column 2
I need this today!
Row 3, Column 3
Not Excited
Row 4, Column 0
Somewhat Excited
Row 4, Column 1
Very Excited
Row 4, Column 2
I need this today!
Row 4, Column 3
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14
Rate your level of excitement for the following:
*
This field is required.
No Interest
Somewhat Interested
Strong Interest
Very Strong Interest
Health focused events, conferences, masterminds, races, workouts with other community members.
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
20 to 45 day virtual challenges where others in the community are competing to reach certain goals.
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Product or service trials where you can test and give feedback on your experience and results.
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Masterclass discussions or Q&A’s from category experts.
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Investment showcases with emerging Health companies looking to raise capital.
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Health focused events, conferences, masterminds, races, workouts with other community members.
20 to 45 day virtual challenges where others in the community are competing to reach certain goals.
Product or service trials where you can test and give feedback on your experience and results.
Masterclass discussions or Q&A’s from category experts.
Investment showcases with emerging Health companies looking to raise capital.
No Interest
Row 0, Column 0
Somewhat Interested
Row 0, Column 1
Strong Interest
Row 0, Column 2
Very Strong Interest
Row 0, Column 3
No Interest
Row 1, Column 0
Somewhat Interested
Row 1, Column 1
Strong Interest
Row 1, Column 2
Very Strong Interest
Row 1, Column 3
No Interest
Row 2, Column 0
Somewhat Interested
Row 2, Column 1
Strong Interest
Row 2, Column 2
Very Strong Interest
Row 2, Column 3
No Interest
Row 3, Column 0
Somewhat Interested
Row 3, Column 1
Strong Interest
Row 3, Column 2
Very Strong Interest
Row 3, Column 3
No Interest
Row 4, Column 0
Somewhat Interested
Row 4, Column 1
Strong Interest
Row 4, Column 2
Very Strong Interest
Row 4, Column 3
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15
Which of the below options best describes your Nutrition plan?
*
This field is required.
I need to eat better but not motivated enough
I try new plans but can't seem to stay on them
I stay 75% - 90% on my plan
I stay 90% + on my plan
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16
If you follow a Nutrition Plan (such as Vegan, Plant Based, Keto, etc.) for at least 75% of the time, please list that here.
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17
Optional: Describe up to three (3) daily, weekly, or monthly practices that you view as the most important to improving your Health.
Recommendation 1
Recommendation 2
Recommendation 3
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18
Optional: Describe up to three (3) products or services that you view as the most effective in improving your Health.
Recommendation 1
Recommendation 2
Recommendation 3
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19
Optional: List up to three (3) books, podcasts, coaches or courses that you have found to make a significant improvement to your Health.
Recommendation 1
Recommendation 2
Recommendation 3
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20
Have you experienced any changes or hurdles that have significantly reduced your Health?
*
This field is required.
If yes, we will capture more details in the next question.
YES
NO
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21
Please describe THE MOST impactful change or hurdle you have experienced in the last 12 months that has significantly REDUCED your Health.
*
This field is required.
Responses will be compiled and shared in a report to all respondents.
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22
What is your current age?
*
This field is required.
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23
Which best describes your current work role?
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Business Owner
Executive
Manager
Professional Trade
Skilled Trade
Other
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24
What was your annual income over the past 12-months?
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$150k or less
$151k - $300k
$301k - $500k
$501k - $1M
Over $1M
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25
Are you or your spouse a member of any of these business networking or mastermind groups?
*
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Please select all that apply
Gobundance
Entrepreneurs Organization
R360
TIGER 21
Strategic Coach
Vistage
CEO Coaching
Genius Network
Abundance 360
Business Network International
No
Other
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26
Select your level of Gobundance membership
*
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Not a member
Gobundance Elite
Gobundance Champion
Gobundance Women
Gobundance Emerge
Member Spouse
Alumni member
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27
Name
*
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First Name
Last Name
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28
Email
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example@example.com
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29
Optional: List any additional business, networking or masterminds groups that you belong to.
We may contact you to help us share this survey with members of these groups.
Group 1
Group 2
Group 3
Group 4
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