Weekly Awareness Survey

Make sure that you are logged in to the membership site before filling out this form to earn 10XP Points.

Name(Required)

First Last

Email(Required)

How would you rate your mood this week?(Required)

1 = Terrible | 10 = Ecstatic

How would you rate your overall fatigue this week?(Required)

1 = Completely Drained | 10 = Not Tired At All

How would you rate your motivation / drive this week?(Required)

1 = Zero Desire to Better Self | 10 = Could Not Stop Thinking About Improvement

How would you rate your recovery this week?(Required)

1 = Feel Overwhelmed Physically & Mentally | 10 = My Body’s Recovery is the Best It Could Be

Please answer accordingly for any anatomical area that you have pain and rate it from 1-10 (If you have no pain, leave everything blank)

Toes

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Ankles

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Achilles

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Calves

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Knees

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Hamstrings

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Groins

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Hip Flexors

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

IT Bands

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Glutes

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Lower Back

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Mid Back

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Upper Back

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Lats

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Abs

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Shoulders

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Arms

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Wrists

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

Neck

(0 = Blank | 1 = No Pain | 10 = I need to go to the doctor)

What are your goals for this week? What do you want to focus on and grow in?(Required)

(Doesn’t have to be movement related)