Survey – Exit Part 2: Your Medical History (Anonymous) As a reminder, the following section survey contains optional questions about your medical history. This portion is anonymous. Both your Coach and Whole30 HQ will only see the data in a group, not by individual survey results. We hope you will take time to complete this survey, because the data is extremely useful to us in better understanding how clients like you are experiencing the Whole30, which will help Whole30 develop more effective education.Your Medical ChangesDuring your Whole30, did you experience any change in dosage for medications in any of the following categories? (Check all that apply) High blood pressure Diabetes High cholesterol Acid reflux Irritable bowel syndrome (IBS/IBD) Polycystic ovarian syndrome (PCOS) Chronic pain Depression Anxiety Insomnia Skin conditions Other Other Did you have new lab work done anytime during your Whole30? Yes No If you answered “yes” to the question above, did you or your physician note any major changes from previous labwork? Please specify. Yes No N/A (I have no new lab results) Please specify Which of the following symptoms have you experienced over the last 30 days, while on your Whole30?DailyAlmost dailySometimesRarelyNeverI don’t knowAcid reflux, heartburn, or indigestionAllergies or sinus issuesAnxiety or depressionBack painBloatingBrain fogConstipationCravingsFatigue or low energyFrequent illnessGI issues (like constipation, diarrhea, gas)Headaches or migrainesJoint pain (general or arthritis)Mood swingsSkin issues (like acne, eczema, or psoriasis)Sleep issues (like frequent waking, insomnia, or oversleeping)StomachachesHow frequently do you currently take over-the-counter medications to treat discomfort from conditions like headaches, joint pain, reflux, or allergies? Daily Weekly Monthly Never Did you experience any body composition change from Whole30? Please specify only if this change was an important aspect for you, and one you feel comfortable sharing. Yes No Please specify Your Emotional Health During and After Whole30The following questions also appeared on the survey you completed for me before your Whole30. Again, I realize the questions in this section can be sensitive. Answering these questions again will help me, you, and Whole30 HQ better understand whether Whole30 brought changes in your body awareness, body acceptance, self-efficacy, or confidence, which can help me to support you and/or future clients in these areas. Please indicate whether each of the following questions is true about you never, seldom, sometimes, often, or always.Never (1)Seldom (2)Sometimes (3)Often (4)Always (5)I respect my body.I feel good about my body.I feel that my body has at least some good qualities.I take a positive attitude toward my body.I am attentive to my body’s needs.I feel love for my body.I appreciate the different and unique characteristics of my body.My behavior reveals my positive attitude toward my body; for example, I hold my head high and smile.I am comfortable in my body.I feel like I am beautiful even ifI am different from media images of attractive people (e.g., models, actresses/actors).Please indicate whether you strongly disagree, disagree, neither agree or disagree, agree, or strongly agree.Strongly disagree (1)Disagree (2)Neither agree nor disagree (3)Agree (4)Strongly agree (5)I will be able to achieve most of the goals that I set for myself.When facing difficult tasks, I am certain that I will accomplish them.In general, I think that I can obtain outcomes that are important to me.I believe I can succeed at most any endeavor to which I set my mind.I will be able to successfully overcome many challenges.I am confident that I can perform effectively on many different tasks.Compared to other people, I can do most tasks very well.Even when things are tough, I can perform quite well.Thank you for taking time to share this information with us.
