You can always press Enter⏎ to continue
Hack Your Lifestyle Quiz
by Heather Binns, Renov8 Fitness
14
Questions
START
Language
English (US)
1
Which habit are you focusing on in this challenge?
*
This field is required.
HYDRATION
NUTRITION
SLEEP
GRATITUDE
FITNESS
Previous
Next
Submit
Press
Enter
2
What's your first and last name?
*
This field is required.
Enter Your FULL Name Here
Previous
Next
Submit
Press
Enter
3
What's NOT currently working in your daily routine?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
4
What's your desired 6-month health & wellness goal?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
5
Where are you at right now in relation to this goal?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
6
What are some of the challenges you face in getting to where you want to be?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
7
Why do you feel this has been your biggest challenge?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
8
How long have you been trying to reach these goals?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
9
Why do you feel you haven't solved this challenge on your own?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
10
What are the determining factors in choosing solutions to help you achieve your desired results?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
11
{whatsYour}, on a scale of 1 to 10, how committed are you to reaching these goals and creating your new healthy lifestyle?
*
This field is required.
1 = I'm not committed
4 = I'm one foot in, one foot out and will probably keep doing the same as today
8 = I'm mostly committed
10 = I'll do whatever it takes to make this happen. I'll invest time, money & resources to make myself a priority and to turn my life around!
Previous
Next
Submit
Press
Enter
12
If you answered anything less than 10, what would have to shift for you to make yourself a priority and choose 10 out of 10?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
13
If you answered 10, what's one thing you can do TODAY to get momentum rolling in this direction?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
14
What's your email to receive your _____?
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform
Question Label
1
of
14
See All
Go Back
Submit