Congratulations on completing 12 weeks of Transform! Please take 5-7 minutes to fill out the items below.

Name *
Name
In the last 30 days, have you used tobacco?
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?
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 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 did health problems limit the kind or amount of work you could do?
In the past 4 weeks (28 days), how often did you not concentrate enough on your work?
On a scale from 0 to 10 where 0 is the worst job performance anyone could have at your job and 10 is the performance of a top worker, how would you rate your overall job performance on the days you worked during the past 4 weeks (28 days)?
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. *