Congratulations on completing the Transform Program! Please take 5 minutes to fill out the items below. This survey will seem similar to a survey you have already taken. Please answer honestly and accurately.

Name *
Name
Regular exercise refers to any weekly physical activity routine. Which best describes you? *
Which best describes you? *
You can type things like brisk walking, jogging, swimming, soccer, yoga, hiking, or any other leisure-time physical activities.
In the last 30 days, have you used tobacco?
In the last 30 days, have you used a smokeless tobacco product?
How would you rate your typical night of sleep? *
In general, how well do you manage your stress?
How often do you get the social and emotional support you need to help you reach your goals?
Approximately how many times are you eating every day? *
In the past 4 weeks (28 days), how often did you do no work at times when you were supposed to be working?
In the past 4 weeks (28 days), how often did you find yourself not working as carefully as you should?
In the past 4 weeks (28 days), how often was the quality of your work lower than it should have been?
In the past 4 weeks (28 days), how often did you not concentrate enough on your work?
In the past 4 weeks (28 days), how often did health problems limit the kind or amount of work you could do?
Do you currently practice in any mindful awareness practices, including but not limited to: mindful meditation, deep breathing exercises, yoga, tai chi, or qigong?
In general, would you say your health is: *
I acknowledge that I have read the Terms of Service and Privacy Policy and consent to the use of this information by Blue Mesa Health. *