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Sculpt your best self.
Step 1 of 12
8%
What habit would you most like to change?
*
Wasting Time
Over sleeping / Sleeping In
Smoking
Unhealthy Eating
Negative Thoughts
Nail Biting
How in control do you feel when you eat?
*
1 (not at all)
2
3
4
5 (very)
How familiar are you with productivity techniques (goal setting, task list, check in with a coach, etc.)?
*
I've never really learned any
I've learned some but don't use them
I use tools weekly
I use tools daily
I'm a productivity monster
How much do you spend on smoking? (monthly)
*
Under $50 USD
$50 to $100
$100 to $200
Over $200
How difficult do you find it to wake up in the morning?
*
1 (not at all)
2
3
4
5 (very)
How long have you been biting your nails?
*
Only recently
1 to 3 years
4 to 9 years
10 to 19 years
20 years or more
How often do you have negative thoughts? (1 to 5 scale)
*
1 (not very)
2
3
4
5 (very often)
How often do you eat?
*
1 (only at meals)
2
3
4
5 (snack all day)
How often do you use a to-do list?
*
Hardly ever / never
Not very often
Some days
Most days
Every day
How many times have you tried to quit?
*
None
1 to 3
4 to 10
10 or more
What are the worst things that have happened to you because you've overslept?
*
Late to work
Missed appointment
Slept through job interview
Slept through a test
Missed a flight
How often do you feel embarrassed about your nails?
*
Very rarely
On occasion
At least a few times per month
A few times ar week
All the time
What are your negative thoughts accompanied by most?
*
General anxiety
Social anxiety
Worry
Depression
Self pity or loathing
What foods do you have the most trouble with?
*
Chips / Pretzels
Pasta
Chocolate
Candy Bars
Soda / Sugary Drinks
Ice Cream
Meats
How many hours weekly do you think you lost wasting time?
*
Less than 10
10 to 19
20 to 29
30 to 39
More than 40
How many years have you been a smoker?
*
Less than 3
3 to 5
5 to 10
10 to 20
More than 20
How often do you oversleep when you shouldn't?
*
Very rarely
Once a month or so
2 to 4 times a month
About twice a week
Almost always
How do you think others judge your nail biting habit?
*
I never really thought about it
People don't really have an opinion
People think I look anxious or stressed
People think I don't have discipline or willpower
People think I have a nervous personality
What would your life be like without negative thoughts?
*
Improved confidence
More energy
Improved relationships
Better health
More work success
What reasons would you want to change your eating habits?
*
Have more energy
Look better
Improve overall health
Better confidence
Improve a specific condition
What reasons would you want to quit smoking?
*
Better health
More energy
Improved relationships
Improved confidence
Save more money / Have money to spend
What would it mean to you if you never overslept again?
*
I would have more time for things I cared about
I would have more job security
Receive a raise at work
My business would improve
People would view me as more reliable
People would stop thinking I was lazy
It would improve my relationships
I would be more alert and engaged in life
Have you ever tried to quit biting your nails?
*
Never
Once
Two or three times
Many times
When are your negative thoughts the heaviest?
*
Morning
Afternoon
Evening
Around other people
At my house
At work
During my commute
Give us any details you'd like to provide about your habit.
On a scale from 1 to 5, how much would you benefit from having a Habit Coach?
1 (not at all)
2
3
4
5 (I NEED a coach to keep me on track)
Would you be interested in paying for a Pavlok Habit Coach?
Yes
Maybe
No
Definitely, right away!!
Pavlok coaches help you set your goals, hold you accountable, and keep you on track. Choose yes if you're interested in having one reach out.
What's your name?
First
Last
What are some questions you have about Pavlok / Shock Clock?
What's your Phone Number?
(We may call/text to assist you with any questions and your habit)
Enter your email address to receive your report
*
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