Food Affects Survey

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Food Affects Survey

Thank you for participating!
You are helping us gather valuable information on how foods affect daily life.

After you complete the survey you will receive a detailed PDF analysis. In addition, a health coach will contact you via email to answer any questions you may have.

Why are we doing this?
Our mission is simple:
"We help people feel better and enjoy life to the fullest!"

First, let's talk about sleep. The nutrition you consume can have quite an impact on your sleep patterns.

Check all that apply *

I fall asleep easily every night and sleep without disruption for 6-8 hours. I occasionally have difficulty falling asleep. I frequently have difficulty falling asleep. I awaken 2-3 times each night for various reasons. I awaken several times during the night, but fall right back asleep. I awaken several times during the night and have trouble going back to sleep. I awaken easily and feel refreshed in the morning. I feel groggy in the morning and wish I could sleep longer. When my alarm goes off, I feel like I just barely fell asleep.

Check all that apply

Next is pain. Choose all that best describe you.

Check all that apply *

I never experience pain without a specific activity that created it. When I wake, I'm stiff and sore until I get moving. I have pain of some sort about 25% of the time. I have pain of some sort about 50% of the time. I am in pain most of the time, but manage it. I am always in pain and am anxious to find relief. My pain is mostly in my joints. Muscle pain is very common for me. I feel pain deep into my bones. My pain is localized in specific body points. My pain moves from place to place and varies in intensity. The pain I experience doesn't affect my life in anyway. There are some activities I enjoy, but can't do anymore because of the pain. I plan my day to minimize the impact of the pain I experience. There is a certain time of day when the pain is worse. I am currently taking prescription medication to manage my pain. I currently exercise to manage my pain.

Check all that apply

On to eating and how food makes you feel.

Check all that apply *

I would like to eat healthy, but don't have time. I eat food that is easy and quick. I take the time to prepare tasty, healthy food for myself. I prepare my own meals most of the time. I eat out more often than I cook. Sometimes, after eating, I feel bloated. After eating certain foods, I get really tired. There are certain foods I avoid because of the negative impact they have on me. I eat at least three meals every day. I don't really fix meals, I just snack throughout the day. I would eat healthy if someone would cook it for me. What I eat isn't as important as just satisfying the hunger. I wish I didn't have to eat. I enjoy the taste and texture of food and try to eat a lot of variety. I have a routine with food that works for me and I rarely deviate from it. I love experimenting with new foods. Eating healthy is way too expensive for me. Organic food is worth the price. I use my microwave every day. I crave sugar and sweets. I crave salty foods. I get sleepy after meals.

How do you feel about exercise?

Check all that apply *

I love to exercise and have a very active lifestyle. My idea of exercise is texting or playing video games. I feel much better when I exercise. I wish I had time to exercise more. I tried exercising and didn't notice much difference in how I felt, so I stopped. I don't have the time or money to exercise. I have a gym membership, but I rarely use it. I don't need a gym membership. I prefer sports or outdoor activities. I really don't think about exercise much. I regularly do some type of cardio exercise. I regularly lift weights. I like variety and exercise in many ways. Exercise? I barely have time to sleep.

Check all that apply

Where do you get your food?

Check all that apply *

The local grocery store. Specialty shops for healthier food. Fast food joints. Sit down restaurants. Take out. Freezer to microwave meals. Convenience stores. Grow it in my garden.

Check all that apply

Do you currently take any supplements?

Check all that apply *

I take a multi-vitamin. I buy supplements online. I get supplements from a local health food store. I have a daily protein drink. I take a pre-workout drink. No. But my partner does.

When you get sick, what do you do?

Check all that apply *

Suffer through it with over-the-counter medications. Go to the doctor for a prescription. Use home remedies. I rarely get sick. I frequently get sick.

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