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My name is...*

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My age is...

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My employment status is...

Employed Full-Time

Employed Part-Time

Full-Time Student

Part-Time Student

On Disability

In-Between Jobs

Not Working

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I live in...*

In the last 7 days, how would you describe your mood?

I’m currently on the floor and I’m not getting shit done

I feel bad most days, but I’m getting shit done

I mostly feel numb - not good or bad

I’m steadily content

I feel good and want to be great

I feel great and am looking to exploring more

I feel awesome - what’s next?!

What is your relationship status?

Relationship status

Select all that apply.

Single & not looking

Single & actively dating

In a relationship (<1 year)

In a relationship (>1 year)

Engaged

Married

Divorced

Other

What is your relationship status?

Other - Please Specify*

Let me know about your current activity levels.

Activity Levels

Sedentary / couch potato

Mild / I don’t move outside of work

Moderate / I take walks

Active / I run and/or workout weekly

Super active / I workout daily or participate in sports

Let me know where to send your results.

Confidential Email*

Phone

This field is for validation purposes and should be left unchanged.

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What are your biggest struggles?

In the last 7 days, how would you describe your mood?

What is your relationship status?

What is your relationship status?

Let me know about your current activity levels.

Let me know where to send your results.