Fit Life Choices Lifestyle Questionnaire

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I want to get to know your lifestyle so I can plan your Fit Life Choices journey. I will reply back with some tips and my suggestion for you to achieve a better life. ~Devon Shurden

Now, the questions, but be honest because I’m not judging.

Let’s start with your first name. *

Thanks. Now, your last name. *

I want to get to know you. What is your age range? *

20-29

30-39

40-49

50-59

60-69

70-80

80+

Are you exercising regularly now?

Yes

Maybe

Clear selection

Honestly, how active are you?

Not at all

Barely

Walk sometimes

Active sometimes

Active daily

Clear selection

In a typical day, how much time do you spend sitting?

4-7 hours

8-10 hours

11-14 hours

15-18 hours

Clear selection

What are your eating habits?

Junk food rules

Balanced meals sometimes

Clean eating always

Clear selection

How often do you drink alcohol each week?

Never do it

Once a week

Some weeks are tough

Maybe more than I should

Clear selection

Do you smoke, anything?

Yes

Maybe

Clear selection

Generally, how much sleep do you get each night?

Not enough

6 hours

7 hours

8 hours

8+ hours

Clear selection

Finally, what email can I use to get back with you? *

Submit

Clear form

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