First Name: Last Name: Have you been feeling anything particular:
Age: Under 30 Between 30 and 60 Over 60
How Is your mood today? Sad Normal Happy Excited
Please Select all that apply: I feel tired after waking up in the morning I have a hard time maintaining energy around noon to evening I have a hard time having any energy after work
How often do you spend time sitting down in a day? I work an office job and spend half my day sitting down I work a driving job and spend all my time sitting down less than 8 hours in a day
Do you participate in any physical activities? Most of my hobbys are completed indoors. not interested in sports. I play sports/hike/gardening. I spend most my free time exerting energy
Anything else to mention?