What’s your name?
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Your email?
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What state do you live in?
Your State Name
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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What do you hope to gain from the Levels Dietary Protocol?
Choose one
Improve energy levels
Weight loss
Improve overall health and wellbeing
Improve mood
Find optimal diet
Just curious
Improve mental clarity
I want to look good and feel good
Not sure
Optimize exercise performace
Preserve current health and prevent illness
Other
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Let us know why you’re interested in Levels
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I understand how glucose tracking relates to my goals for nutrition, wellness, or exercise
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
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How often do you feel tired or low energy in the morning? mid-day? after dinner?
Rarely
Once in a while
Somewhat often
Very often
Daily
Morning
Rarely
Once in a while
Somewhat often
Very often
Daily
Mid day
Rarely
Once in a while
Somewhat often
Very often
Daily
Evening
Rarely
Once in a while
Somewhat often
Very often
Daily
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How often do you have mood swings, and when do they occur during the day?
Rarely
Once in a while
Somewhat often
Very often
Daily
Morning
Rarely
Once in a while
Somewhat often
Very often
Daily
Mid day
Rarely
Once in a while
Somewhat often
Very often
Daily
Evening
Rarely
Once in a while
Somewhat often
Very often
Daily
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How did you hear about Levels?
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How often do you exercise?
Rarely
Once in a while
Somewhat often
Very often
Daily
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How healthy do you feel
your diet is?
Not healthy
1
2
3
4
5
Very healthy
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Do you go out of your way to buy healthy/organic/unprocessed food?
no
Yes
Other
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Do you currently have or ever had a dietician or nutritionist?
no
Yes
Other
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Do you own a fitness/sleep wearable or smartwatch?
no
Yes
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