How would you rate your sleep quality over the past two weeks?
How many hours do you typically sleep per night?
How consistent is your energy throughout the day?
1 = severe crashes, 10 = steady and reliable
Which best describes your typical morning state?
Refreshed & clear
Slow start, builds
Tired but functional
Consistently fatigued
How often do you experience deep, uninterrupted focus (flow states) in your work?
Rarely/never
Once a week
Several times/week
Daily
Rate your ability to concentrate when you need to.
How often do you feel mentally foggy or "dim"?
Most days
A few times/week
Occasionally
Rarely
What are your biggest focus disruptors? (select all that apply)
Phone/notifications
Noise/environment
Anxiety/racing thoughts
Low energy
Unclear priorities
Other people
Hunger/caffeine
What is your average perceived stress level over the past month?
How well do you recover after a stressful event or day?
Carries over for days
Takes 1–2 days
By next morning
Within hours
How often do you have intentional "down-regulation" practices (breathwork, meditation, nature, stillness)?
Never
Occasionally
Weekly
Daily
Rate your overall emotional baseline right now.
1 = persistently low/anxious, 10 = grounded and content
How nourishing are your close relationships right now?
How often do you engage in activities purely for joy or play?
Almost never
Monthly
Weekly
Daily
How do you typically recharge? (select all that apply)
Solitude/quiet
Social connection
Nature
Creative pursuits
Exercise
Entertainment/media
Sleep/napping
In your own words, what feels most out of balance in your life right now?