Sculpt your best self. Step 1 of 12 8% What habit would you most like to change?*Wasting TimeOver sleeping / Sleeping InSmokingUnhealthy EatingNegative ThoughtsNail Biting How in control do you feel when you eat?*1 (not at all)2345 (very)How familiar are you with productivity techniques (goal setting, task list, check in with a coach, etc.)?*I've never really learned anyI've learned some but don't use themI use tools weeklyI use tools dailyI'm a productivity monsterHow much do you spend on smoking? (monthly)*Under $50 USD$50 to $100$100 to $200Over $200How difficult do you find it to wake up in the morning?*1 (not at all)2345 (very)How long have you been biting your nails?*Only recently1 to 3 years4 to 9 years10 to 19 years20 years or moreHow often do you have negative thoughts? (1 to 5 scale)*1 (not very)2345 (very often) How often do you eat?*1 (only at meals)2345 (snack all day)How often do you use a to-do list?*Hardly ever / neverNot very oftenSome daysMost daysEvery dayHow many times have you tried to quit?*None1 to 34 to 1010 or moreWhat 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 rarelyOn occasionAt least a few times per monthA few times ar weekAll the timeWhat are your negative thoughts accompanied by most?*General anxietySocial anxietyWorryDepressionSelf 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 1010 to 1920 to 2930 to 39More than 40How many years have you been a smoker?*Less than 33 to 55 to 1010 to 20More than 20How often do you oversleep when you shouldn't?*Very rarelyOnce a month or so2 to 4 times a monthAbout twice a weekAlmost alwaysHow 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 energyLook betterImprove overall healthBetter confidenceImprove a specific conditionWhat 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?*NeverOnceTwo or three timesMany timesWhen 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)2345 (I NEED a coach to keep me on track) Would you be interested in paying for a Pavlok Habit Coach?YesMaybeNoDefinitely, 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* This iframe contains the logic required to handle Ajax powered Gravity Forms.