Date:6 September 2010

Hello and Welcome to the Elevate Performance Assessment.

This assessment tool is designed to provide you with a detailed insight into your health, and into how you are currently performing. At the end of the assessment you will receive your score and suggestions on how to improve it.

Note: we will only store your data if you check the box below. If not, your survey will be anonymous.

Please tick a box for each answer marked 1-5, 1 representing the lowest score and 5 representing the highest score.

ENJOY!

I wish for Elevate to record my data

BRAINWAVES

1. Do you wake up mentally ready to perform at your best every day?
1 2 3 4 5

2. Are you able to overcome negative thoughts with positive ones?
1 2 3 4 5

3. Do you regularly take time out alone to "get your head right"?
1 2 3 4 5

4. Are you able to easily focus on tasks at home or at work?
1 2 3 4 5

5. Do you consider yourself to be optimistic? Do you continually challenge yourself to improve your mindset?
1 2 3 4 5

6. Do you continually challenge yourself to improve your mindset?
1 2 3 4 5

FUEL

1. Do you understand how to fuel your body for energy and performance?
1 2 3 4 5

2. Do you manage your weight consistently?
1 2 3 4 5

3. Is more than 70% of what you eat natural unprocessed whole foods?
1 2 3 4 5

4. Do you eat at least 2 different types of fresh fruit and 5 different types of veg every day?
1 2 3 4 5

5. Do you drink at least 8 glasses of water daily?
1 2 3 4 5

6. Do you take vitamin/mineral/herbal supplements as part of your healthcare program?
1 2 3 4 5

MOTION

1. Do you perform some sort of vigorous movement most days?
1 2 3 4 5

2. Are you comfortable and pain free while you work?
1 2 3 4 5

3. Do you enjoy exercise?
1 2 3 4 5

4. Are you consistent in the amount of activity you perform each week?
1 2 3 4 5

5. You always feel pain free and in tip top shape?
1 2 3 4 5

6. Are you happy with your current health and fitness levels?
1 2 3 4 5

REJUVENATE

1. Do you get enough sleep to perform at your peak consistently?
1 2 3 4 5

2. Is your sleep unbroken, quality sleep that leaves you feeling refreshed when you wake up?
1 2 3 4 5

3. Do you meditate or take part in relaxing exercise like Yoga?
1 2 3 4 5

4. Do you plan annual holidays and weekly activities that you enjoy?
1 2 3 4 5

5. Are you able to switch off completely from work when sleeping and enjoying time off?
1 2 3 4 5

6. Do you spend time alone daily to slow down and recharge?
1 2 3 4 5

TIME

1. Do you prioritise important tasks and plan your week accordingly?
1 2 3 4 5

2. Do you have enough time to achieve everything you need to each day?
1 2 3 4 5

3. Do you avoid multitasking?
1 2 3 4 5

4. Do you block out time for all aspects in your life including family, work, exercise, rest and self improvement?
1 2 3 4 5

5. Do you leave time for the unexpected?
1 2 3 4 5

6. Do you work on high end tasks when you are most alert?
1 2 3 4 5

STRESS

1. Do you manage your stress effectively?
1 2 3 4 5

2.Have you ever experienced any dizziness, palpitations or anxiety during or after a stressful event?
1 2 3 4 5

3. Are you responsive (rather than reactive) in certain situations?
1 2 3 4 5

4. Can you access a calm state under pressure?
1 2 3 4 5

5. Do you have a number of strategies that you can use for overcoming stress?
1 2 3 4 5

6. Do you listen to your mind and body and take some time out when you are stressed?
1 2 3 4 5

BIG PICTURE

1. How do you rate your health and performance overall?
1 2 3 4 5

2. Do you take responsibility for your health by seeing a health practitioner when symptoms arise?
1 2 3 4 5