Client Questionnaire · BrainTrainings Academy

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Personal information

Full name*

Age*

Helps link this questionnaire to your account if you register later

Education

Educational institution

Field of study

Was school easy for you? What were the results?

Was university easy for you?

Foreign language proficiency?

Work

Field of work

How many hours a day do you work?

What is your work schedule? Any night shifts?

When during the day are you most productive?

Do you have a habit of working at night?

How would you rate your work stress level?

1 — minimal10 — maximum

What factors can distract you from work tasks?

How often do you get distracted during work?

How long does it take you to get into a work task?

How quickly do you get tired?

When was your last vacation and how long was it?

Did you manage to fully rest?

Yes

Partially

Health and sleep

Have you had COVID? If yes, when?

What vaccinations have you had in the past year?

Have you had general anesthesia? If yes, when?

How often do you get headaches?

How often do you get sick?

How is your vision? Do you see an ophthalmologist regularly?

What medications and supplements are you currently taking?

Do you smoke?

Yes

Quit

Do you drink alcohol? If yes, how often?

How many cups of coffee do you drink per day?

How do flights and long trips affect your physical state?

What time do you wake up and go to bed?

What is your average sleep duration?

How quickly do you fall asleep, how often do you wake up at night?

Nutrition

How often do you consume sweets (desserts, chocolate, sweet drinks)?

How much water do you drink per day?

What is your eating schedule?

Do you have dietary restrictions or preferences?

Sports

Do you currently do sports?

Yes

What sport and how many hours per week?

What sports did you do in childhood and for how many years?

Hobbies

Do you have any hobbies now? If yes, what?

Did you engage in any creative pursuits earlier or in childhood? If yes, which?

What activity helps you recover and relax?

What you want to change

What do you notice in yourself that you would like to improve?

Free form — write in your own words whatever comes to mind. No prompts or categories.

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Why this questionnaire matters