Personal Health and Lifestyle Survey

What is your age group?

Select your age range.

18–24

25–34

35–44

45+

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What is your profession or lifestyle type?

Choose one that best describes you.

Student

Working Professional

Homemaker

Unemployed

Retired

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How would you describe your daily activity level?

Select one option.

Sedentary (little to no exercise)

Lightly Active (light exercise/sports 1-3 days/week)

Moderately Active (moderate exercise/sports 3-5 days/week)

Very Active (hard exercise/sports 6-7 days a week)

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What type of diet do you follow?

Please select one option.

Vegetarian

Vegan

Non-Vegetarian

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How would you rate your sleep quality?

Select one option.

Poor

Average

Good

Excellent

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Do you regularly exercise (at least 30 minutes)?

Select Yes or No.

Yes

No

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If yes, how often do you exercise?

Select one option.

1–2 times a week

3–5 times a week

Daily

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What are your health goals?

Select all that apply.

Weight Loss

Muscle Gain

Better Sleep

Stress Reduction

Other

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What is your biggest health challenge right now?

Share any specific challenges you face regarding your health.