1. In general, how would you describe your overall hygiene?
2. In general, how would you describe the condition of your mouth
and teeth?
3. On how many of the last 7 days did you brush and floss your
teeth?
4. On how many of the last 7 days did you engage in moderate to
strenuous exercise(such as a brisk walk)?
5. On those days that you engaged in moderate to strenuous exercise,
how many minutes on average, do you exercise at this level?
6. How much of a priority is exercising?
Over the past seven days
1. How many times did you eat snacks, fast food, or pizza?
2. How many servings of fruits or vegetables did you eat each day?
3. How many sodas and sugar-sweetened beverages did you consume(on
average)each day?
4. How often did you consume a full breakfast?
5. Did you consume any medications?
1. How many hours do you sleep on average each night?
2. During the past month, how woud you rate your sleep quality
overall?
3. Do you go to bed and wake up at the same time every day. Even on
weekends?
4. How likely is it that you would fall asleep during the daytime
without intending to or that you would struggle to stay awake while
you were doing things?
5. How often do you have trouble going to sleep or staying asleep?
6. During the past 2 weeks, for about how many days did you have
loud snoring?
7. During the past 2 weeks, for about how many days did you fall
asleep while using you phone?
Over the past week how many days have these issues bothered you?
1. Feeling nervous, anxious, or on edge?
2. Not being able to stop or control worrying?
3. Worrying too much about different things?
4. Trouble relaxing?
5. Being so restless that it is hard to sit still?
6. Becoming easily annoyed or irritable?
7. Feeling as if you do not have enough time to do what you set out
for yourself?