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aceRESET Questionnaire


About you


What's your gender? *

Lifestyle


Health and behaviour history


Are you pregnant? *
Have you had a baby in the last 6 months? *
Are you breastfeeding? *Please note that this programme may have an effect on the quality of your milk.
Please also include what type of birth you had - natural/C-section

Are you going through perimenopause? *

Please expand
Please expand

Would you say you are an all-or-nothing person? *

Have you ever had obsessive behaviours, mostly when dieting? *

Please include as much detail as possible
Please give us details

Exercise history


Do you currently exercise?

Dieting history

Are you or have you ever been on a diet? *

Do you consider yourself as an emotional and/or binge eater? *

Have you ever lost your period? *

Have you ever tracked your calorie intake before? *

Nutrition


Please explain either way
i.e., motivation, lack of knowledge
PLEASE NOTE THAT WE NEED PARTICIPANTS TO PUT IN 100% TO ACHIEVE THE BEST POSSIBLE RESULTS
10 being the most important!

Terms and conditions *

Physical Activity Readiness Questionnaire (PAR-Q)

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions please read carefully and answer each one honestly: check YES or NO.


Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had a chest pain when you were not doing physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing medication? (for your blood pressure, heart condition etc?) *
Do you suffer from Asthma? *
Do you suffer from Epilepsy? *
Do you know of any other reason why you should not do physical activity? *

Signed *

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