Whole30 Coaches Site Logo
  • HOME
  • SEARCH OUR COACHES
  • EVENTS
  • LOGIN
  • BACK TO Whole30

Survey – Welcome



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 History

As your Coach, it’s good for me to be aware of any medical history that might impact - or be impacted by - your Whole30 experience. It also helps me (and you) assess how these things might have changed at the end of your Whole30.
In the past 5 years, have you had abnormal lab values in any of the following areas? (Check all that apply)(Required)
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 take over-the-counter medications to treat discomfort from conditions like headaches, pain, reflux, or allergies?
Have you experienced a significant weight change (more than 10% of your body weight) in the past year?

Your Emotional Health

I realize the questions in this section can be sensitive. This information will only be used to help me, you, and Whole30 HQ better understand how Whole30 impacts changes in your body awareness, body acceptance, self-efficacy, and confidence. It can also help me to better tailor your Coaching experience.
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.

Optional Demographic Information

If you feel comfortable, please provide the following demographic information. This question is optional and will be used to help me (and Whole30 HQ) better understand how people in different age groups experience Whole30.
What is your age bracket?(Required)

Thank you for taking time to share this information with us.

©2023 Thirty & Co, LLC Whole30® and the Whole30 logo are registered trademarks of Thirty & Co, LLC
Privacy Policy Terms of Service