O W N E R S H I P

Name *

First Name

Last Name

Ok. Now let's talk lifestyle. On average, how many hours a night are you currently sleeping? *

5-6 Hours

7-8 Hours

8+ Hours

It’s so intermittent and of such poor quality, that I’m not sure it even counts

What about your nutrition? Which of the following statements *best* describes your relationship with food (choose one): *

Food is pleasure. First and foremost.

Eating is part of my routine in terms of what I eat and when. Call me habitual.

I eat for nourishment and am typically always cognizant of the fuel I am choosing to put in my body.

Every day is an adventure. There is very little rhyme or reason behind what and when I eat.

I'm honestly rather indifferent to food and can often forget to eat.

Moving on to stress. Which of the following statements apply to you (check all that are relevant): *

My life is pretty comfortable. Worrying is not something I partake in regularly.

There are good days and bad days, but overall I think I have a good handle on my headspace.

There are factors that, even though they are out of my control, admittedly consume me.

I sometimes experience physical anxiety (heart racing, tightness in my chest, headaches, etc.).

Alright. Now it's time to talk movement. Which of the following statements best describes your inner dialogue (choose one) surrounding your workouts: *

There is no dialogue. My body hasn't moved in a meaningful way in some time.

Do it because you SHOULD.

I really want to, know I need to, but there is just. so. darn. much. to get done.

You'll never regret reminding yourself of just how strong you are.

My brain wants to, but my body is so tired that it's a no.

Just curious, when's the last time you took vacation? And because we know you're going to ask, for the purposes of this question, we are defining "vacation" as 5 days in a row of no work or regular household obligations required. *

Within the past 3 months

3-6 months ago

6 months – 1 year ago

Let's just say it's been a long time.

The work thing is tripping me up. I've taken time off, but not fully from work.

Does being sick count?

How would you describe your ability to hold yourself accountable (choose one)? *

I'm a solid self-starter and intuitively implement systems to keep myself in check.

Not great, but I know this about myself, so I've learned to recruit others to help in this pursuit.

Give me a carrot on a stick, and I'm good. I'm very earn/reward.

Isn't this what The U is for?

HELP!

Now it's time to move on to the physical assessment. Let's start by looking at some specific movement patterns and how they feel on your body. For starters, stand up and reach your arms straight up over your head 5 times. Do any of the following occur (check all that apply):

My elbows bend; I cannot keep them straight over my head

My ribs puff open and my lower back arches (cannot keep my lifejacket on)

There’s tightness, pain or discomfort in one or both of my shoulders

None of the above apply to me

Next, we're going to look at your forward bend. Stand up with your feet together, legs straight, and reach your fingers towards your toes. Which of the following statements apply (check all that are applicable)? *

My fingers cannot get to the floor unless I bend my knees

I feel a pull in my lower back as opposed to the back of my legs

I can get my palms to the floor in front of my toes

Moving on to your single-leg balance. Stand up with your feet together and place your hands on your hips. Standing as tall as you can, pick one foot off the floor and hold your balance for a minute maximum on each side. Which of the following statements apply (check all that are applicable)? *

I lost my balance before I hit the 45-second mark

I couldn’t lock out my standing leg

I had to stop because I felt a burning/discomfort in my lower back

It was relatively easy for me to complete both sides for a minute