Online Road to Health Program- Questionnaire

Energy

Quick Self Test (5 min)

This 5-minute questionnaire is designed to assess how you’re feeling across 5 key areas: Energy, Sleep, Mood, Cravings, and Motivation. Based on your answers, we’ll help guide you through personalized steps.

0 – Not at all 5 – Neutral 10 – Extremely

How satisfied am I with my overall energy level?

What is my energy level upon waking up?

What is my energy level in the afternoon?

What is my energy level after meals?

What is my energy level during working hours?

I do not need coffee to get through my day.

EnergyCalc-1

Sleep

Quick Self Test (5 min)

This 5-minute questionnaire is designed to assess how you’re feeling across 5 key areas: Energy, Sleep, Mood, Cravings, and Motivation. Based on your answers, we’ll help guide you through personalized steps.

0 – Not at all 5 – Neutral 10 – Extremely

How satisfied am I with my sleep?

It is easy for me to fall asleep.

I rarely wake up in the middle of the night.

I wake up feeling refreshed.

I never feel sleepy during the day.

I never feel the need to take naps during the day.

SleepCalc

Mood

Quick Self Test (5 min)

This 5-minute questionnaire is designed to assess how you’re feeling across 5 key areas: Energy, Sleep, Mood, Cravings, and Motivation. Based on your answers, we’ll help guide you through personalized steps.

0 – Not at all 5 – Neutral 10 – Extremely

I rarely feel down or unhappy.

I rarely get stressed or irritated with things.

I rarely eat something sweet to feel better.

I have no trouble with concentration.

I rarely feel depressed or anxious.

My mood is pretty steady throughout the day.

MoodCalculations-3

Food Cravings

Quick Self Test (5 min)

This 5-minute questionnaire is designed to assess how you’re feeling across 5 key areas: Energy, Sleep, Mood, Cravings, and Motivation. Based on your answers, we’ll help guide you through personalized steps.

0 – Not at all 5 – Neutral 10 – Extremely

I am in control of what and when I want to eat.

I don't need sugar to get through my day.

I feel satisfaction between meals.

When I am hungry, I am okay with waiting to eat.

I rarely think of having dessert or something sweet after a meal.

I rarely eat sweet snacks throughout the day.

FoodCalculations-4

Motivation

Quick Self Test (5 min)

This 5-minute questionnaire is designed to assess how you’re feeling across 5 key areas: Energy, Sleep, Mood, Cravings, and Motivation. Based on your answers, we’ll help guide you through personalized steps.

0 – Not at all 5 – Neutral 10 – Extremely

I am willing to learn new skills that will help me in my work/life.

I have a strong desire to achieve and excel.

I am open to criticism and willing to improve myself.

I set goals for self improvement.

I am willing to work hard to meet my personal goals.

I find it easy to implement a change in something I used to do when there is a need.

MotivationsCalculations-5

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