Name *

First Name

Last Name

Does your job include shift work? *

Yes

No

My job is very active *

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Do you smoke (or vape)? If yes, how many cigarettes per day? *

I don't smoke/vape

1-3

4-6

6+

Vape

On average, how many hours do you sleep per night? *

5 or fewer

Between 5 and 7

7 or more