Blindspots & Breakthroughs Questionnaire
Please pause for a moment to invest in your health. This life-changing questionnaire takes about 10 minutes to complete. Each of the 60+ questions will help illuminate your blind spots and any functional limitations, allowing us to create a plan to rapidly transform your body and your life! Please answer all questions before submitting.
What's your height and current weight?
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What is your main reason for seeking help for your health & fitness right now? In other words, what's your main goal?
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In which part(s) of your life do you feel you most need a breakthrough? (multiple answers ok)
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In which part(s) of your life do you feel you most need a breakthrough? (multiple answers ok)
How urgent is your need to change?
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How urgent is your need to change?
Please list any medical conditions that you've been diagnosed to have
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Please list any medications you're currently taking
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Please list any history of chronic illness in your family (e.g. diabetes, heart disease, mental health, etc)
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Do you feel better physically when you eat meat frequently, sometimes or never?
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Do you feel better physically when you eat meat frequently, sometimes or never?
Do you feel best when you eat a meal that's high in protein and fat or one that's predominantly vegetables and starches?
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Do you feel best when you eat a meal that's high in protein and fat or one that's predominantly vegetables and starches?
How easy is it for you to gain weight (both muscle and fat)
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How easy is it for you to gain weight (both muscle and fat)
How much of your food intake is processed -- that is, from a package, can, box, or fast food?
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How much of your food intake is processed -- that is, from a package, can, box, or fast food?
Overall, how much of your diet is organic?
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Overall, how much of your diet is organic?
What is your total intake of vegetables (both cooked and raw) in your diet?
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What is your total intake of vegetables (both cooked and raw) in your diet?
How many glasses of water do you drink daily?
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How many glasses of water do you drink daily?
Do you drink predominantly tap water or bottled water?
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Do you drink predominantly tap water or bottled water?
How many cups of caffeinated beverages do you drink daily?
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How many cups of caffeinated beverages do you drink daily?
How many alcoholic drinks do you drink in a week?
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How many alcoholic drinks do you drink in a week?
How many sweets do you consume daily? (candy, pastries, sweetened drinks, etc)
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How many sweets do you consume daily? (candy, pastries, sweetened drinks, etc)
How often do you eat store-bought salad dressings, cereals, or baked goods?
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How often do you eat store-bought salad dressings, cereals, or baked goods?
Please list any vitamins or supplements that you take regularly
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In recent years, would you say you've gained, maintained, or lost muscle mass?
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In recent years, would you say you've gained, maintained, or lost muscle mass?
How often do you feel irritable, fatigued, or depressed?
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How often do you feel irritable, fatigued, or depressed?
How would you describe your general physical energy level?
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How would you describe your general physical energy level?
If you are female, do you have significant symptoms of PMS, menopause, or other hormone-related issues? Please describe briefly if so
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Have you experienced significant hair loss, acne, or unexplained weight changes in recent years?
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Have you experienced significant hair loss, acne, or unexplained weight changes in recent years?
How would you describe your libido or sex drive?
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How would you describe your libido or sex drive?
Do you have trouble with temperature regulation? (feeling too hot or too cold)
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Do you have trouble with temperature regulation? (feeling too hot or too cold)
Do you experience frequent pain in any part of your body? If so, please describe
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How consistenly do you plan downtime, recovery time, self-care time into your weekly schedule? ("me time" when you can be alone, naps, hot baths, massages, "unproductive" time, reading for pleasure, etc)
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How consistenly do you plan downtime, recovery time, self-care time into your weekly schedule? ("me time" when you can be alone, naps, hot baths, massages, "unproductive" time, reading for pleasure, etc)
EMOTIONAL AND MENTAL HEALTH
From 1-10, how regularly do you practice any self-awareness rituals (e.g. journaling, therapy, meditation?)
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From 1-10, how much "shadow work" have you done to release trapped emotions or shift subconscious beliefs?
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Do you notice patterns in your romantic life, finances, or physical health, but you generally don't understand what's causing them?
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Do you notice patterns in your romantic life, finances, or physical health, but you generally don't understand what's causing them?
If 10 is total willingness and 1 is feeling fearful and cautious, how ready are you to look at painful experiences in your past or present?
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How clearly do you know your life purpose?
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How clearly do you know your life purpose?
Do you have a history of battling with depression or anxiety?
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Do you have a history of battling with depression or anxiety?
How would you describe your daily interaction with loved ones in the last few years or months?
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How would you describe your daily interaction with loved ones in the last few years or months?
How would you describe your worklife dynamics?
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How would you describe your worklife dynamics?
How often do you experience lower abdominal bloating or discomfort?
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How often do you experience lower abdominal bloating or discomfort?
For you, is bloating & gas more likely caused by a high-fiber meal like broccoli & brown rice or by lots of sweets and bread products?
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For you, is bloating & gas more likely caused by a high-fiber meal like broccoli & brown rice or by lots of sweets and bread products?
Do you frequently have loose stools or diarrhea?
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Do you frequently have loose stools or diarrhea?
How often do you experience constipation?
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How often do you experience constipation?
Have you ever been diagnosed with IBS or leaky gut?
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Have you ever been diagnosed with IBS or leaky gut?
How often do you crave foods like bread, chocolate, sugary fruits or red meat of you've not had them in a while?
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How often do you crave foods like bread, chocolate, sugary fruits or red meat of you've not had them in a while?
Have you ever taken antibiotics?
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Have you ever taken antibiotics?
Do you ever have heartburn or indigestion?
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Do you ever have heartburn or indigestion?
ENERGY LEVELS AND CIRCADIAN RHYTHM
On a scale of 1-10, how would you rate your daily energy level?
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Do you often feel tired, even after a full night's sleep?
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Do you often feel tired, even after a full night's sleep?
Do you travel across time zones frequently?
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Do you travel across time zones frequently?
What time do you usually go to bed and wake up?
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Do you often wake up between 1am and 4am and have trouble falling back asleep?
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Do you often wake up between 1am and 4am and have trouble falling back asleep?
After lunch, do you often feel drowsy & want to take a nap?
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After lunch, do you often feel drowsy & want to take a nap?
How good are you with time management, meeting deadlines, and being on time?
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How good are you with time management, meeting deadlines, and being on time?
PARASITES AND SYSTEMIC FUNGUS
Do you have pets now or in the recent past?
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Do you have pets now or in the recent past?
From 1-10, how stressful is your life overall?
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Do you have a history of recurring yeast infections, athlete's foot, or other fungal issues?
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Do you have a history of recurring yeast infections, athlete's foot, or other fungal issues?
Do you have frequent cravings for sugar, bread products, and/or dairy?
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Do you have frequent cravings for sugar, bread products, and/or dairy?
Do you experience itching in the ears, nose, or rectum?
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Do you experience itching in the ears, nose, or rectum?
Do you sometimes have rashes or unexplained skin issues?
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Do you sometimes have rashes or unexplained skin issues?
FITNESS AND PHYSICAL ACTIVITY
Do you currently exercise regularly? If yes, what type and how often?
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How would you describe your current fitness level?
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How would you describe your current fitness level?
From 1-10, How active is your lifestyle overall? (1 is totally sedentary, 10 is extremely active)
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From 1-10, how much do you care about and actively maintain good posture & form when you walk, sit, stand, and exercise?
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How much of my total time, energy, and action each day is directed towards maintaining and cultivating my own health?
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How much of my total time, energy, and action each day is directed towards maintaining and cultivating my own health?
If you've tried but failed to change in the past, what got in the way?
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What about Greg (the Planet Doctor) or his approach makes you feel open to his help and guidance?
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Why MUST you change now? (why is staying in your current condition no longer an option?)
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SUBMIT this form to see the NEXT STEPS for your BREAKTHROUGH