Survey Name * First Name Last Name Email Address * Phone (###) ### #### Survey * I care about about my health Strongly Disagree Disagree Neutral Agree Strongly Agree I go out of my way to to make healthy lifestyle choices Strongly Disagree Disagree Neutral Agree Strongly Agree I am happy with the amount of physical activity I do Strongly Disagree Disagree Neutral Agree Strongly Agree I have lots of energy throughout the day Strongly Disagree Disagree Neutral Agree Strongly Agree I get 7-8 hours of sleep per night Strongly Disagree Disagree Neutral Agree Strongly Agree I am happy with the way that I look and feel Strongly Disagree Disagree Neutral Agree Strongly Agree I want to improve my health and fitness Strongly Disagree Disagree Neutral Agree Strongly Agree Additional Notes Thank you! Contact us
