Tack180 Performance Health Questionnaire
First Name
Last Name
Email
Have you made any progress towards your goals since beginning Tack180?
How many times a week do you exercise?
List exercises, frequency, and duration
How do you feel now compared to before Tack180?
Please describe your diet briefly.
What impact did Tack180 have on your health (1-5 scale from no effect to greatly improved)?
Select...
1 - No Effect
2 - Minimal Improvement
3 - Moderate Improvement
4 - Good Improvement
5 - Great Improvement
How many hours of sleep do you get?
Do you feel rested most mornings?
Select...
Yes
No
What do you do to manage stress (all)?
Select...
Yoga
Meditation
Journaling
Prayer
Exercise
Visual Imagery
Tai Chi
Other
List each stress management practice, frequency, and duration.
List your medications and supplements.
What else would you like us to know?
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