21-Day No Alcohol Challenge Survey and Assessment

*must fully complete this survey to be eligible for the $1,000 prize

After you hit submit you will be prompted to register for our challenge wrap up call and winner announcement.

Challenge Results

Step 1 of 3

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Name(Required)

First Last

Date(Required)

MM slash DD slash YYYY

Email(Required)

Phone(Required)

Height (Inches)(Required)

Current Weight

Approximate weight when starting the challenge?

What was your biggest win from the challenge?(Required)

What was your primary goal when starting the challenge?*(Required)

Weight Loss (more than 20 pounds to lose)

Performance (optimize my performance for a sport)

Build Muscle (build lean tissue to improve body composition and strength)

Health/Longevity (I want to live my life the best way possible. I want to feel my best!)

Aesthetics (I just want to look good naked! I have an event coming up I want to prepare for)

Other

Have you made progress toward that goal during your time in the challenge?*(Required)

I reached my goal!

I have made progress and am looking to make additional progress

I have not made progress but I’ve developed important and sustainable habits

Other

What was your biggest struggle during the challenge?(Required)

What goals do you want to work on next, or continue to work on?*(Required)

How many calories on average are you eating per day?(if not tracking, provide a rough estimate)(Required)

How would you rate your food quality?(Required)

1 – Not Paying any attention to what I'm eating – poor quality food2345678910 – Eating green veggies at a minimum of 2 meals per day/80% whole foods

How would you rate your protein intake?(Required)

1 – Barely eating protein2345678910 – Eating close to or at 1g per pound of body weight (or protein with 2-3 meals per day)

Do you find yourself consuming large amounts of coffee or energy drinks to get through the day?(Required)

How would you rate your daily energy levels?(Required)

1 – Very low energy2345678910 – Very high energy

Do you find that you are able to cope with and manage your day to day stress?(Required)

How do you cope with day to day stress (ex. walks alone, meditation, reading, watching TV)?

On average, how many hours of sleep do you get each night?

6 or less hours of sleep per night

7 or less hours of sleep per night

7-9 hours of sleep per night

Other

How would you rate the quality of your sleep?(Required)

1 – Wake up several times per night/wake up tired2345678910 – Sleep like a rock/Very well rested upon waking

How would you rate your daily stress levels?(Required)

1 – No stress at all2345678910 – Very high levels of stress

Do you have a sleep routine (I.e. go to bed and wake up at generally the same time each day)(Required)

How active are you?(Required)

Very sedentary (no exercise routine/desk job)

Sedentary (no exercise routine/minimally active during the day)

Moderately active (exercise 1-2 days per week/about 5k steps a day)

Active (consistent exercise 2-3 days per week/active throughout the day)

Highly active (physically demanding job/consistent exercise or consistent exercise 4-5 days per week and 8-10k steps/day)

Other

What is one thing you would improve for next challenge?(Required)

Are you currently a 1:1 coaching client?(Required)

Yes

No

Please upload a picture of your current Challenge Tracker

Max. file size: 256 MB.

Please upload before/after images here.

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