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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 Changes

During your Whole30, did you experience any change in dosage for medications in any of the following categories? (Check all that apply)
Did you have new lab work done anytime during your Whole30?
If you answered “yes” to the question above, did you or your physician note any major changes from previous labwork? Please specify.
DailyAlmost dailySometimesRarelyNeverI don’t know
Acid reflux, heartburn, or indigestion
Allergies or sinus issues
Anxiety or depression
Back pain
Bloating
Brain fog
Constipation
Cravings
Fatigue or low energy
Frequent illness
GI issues (like constipation, diarrhea, gas)
Headaches or migraines
Joint pain (general or arthritis)
Mood swings
Skin issues (like acne, eczema, or psoriasis)
Sleep issues (like frequent waking, insomnia, or oversleeping)
Stomachaches
How frequently do you currently take over-the-counter medications to treat discomfort from conditions like headaches, joint pain, reflux, or allergies?
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.

Your Emotional Health During and After Whole30

The 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.
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).
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.

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