GeneHack - Pre-Consulting Questionnaire

BEFORE YOU BEGIN — WHY THIS QUESTIONNAIRE MATTERS

Your GeneHack analysis studies how your epigenetic markers interact with your lifestyle, habits, stress levels, nutrition, recovery, and environment.

To give you the most precise, personalized, and effective performance and intervention roadmap, we need to understand how you currently feel and function.

This questionnaire helps us:

Map your real-world experiences to gene expressions
Identify patterns that influence your mental sharpness, endurance, recovery, metabolism, stress response, and longevity
Understand your unique strengths and areas needing support
Build a custom, high-impact plan tailored to your ambitions

Each question is rated from 1 to 10:

1 = Minimal — the lowest or least effective level of how you feel or function.

10 = Optimal — the highest, most efficient, and best possible state of your performance or wellbeing.

SECTION A — PERSONAL INFORMATION

Name: *

Age:

Gender:

Mobile Number:

Email:

Your top 3 goals (physical or mental):

SECTION B — MIND & COGNITIVE PERFORMANCE

Your brain's performance determines how efficiently you think, react, focus, and make decisions. This section helps us understand your cognitive load, mental patterns, and key brain-related gene expressions.

1. Mental clarity — how clear, light, and sharp your mind feels.

Rating:

1 = Minimal 10 = Optimal

Comments:

2. Focus & concentration — ability to stay on a task without getting distracted.

Rating:

1 = Minimal 10 = Optimal

Comments:

3. Reaction speed — how quickly you respond to situations or make decisions.

Rating:

1 = Minimal 10 = Optimal

Comments:

4. Memory recall — how easily you remember information or tasks.

Rating:

1 = Minimal 10 = Optimal

Comments:

5. Mental stamina — ability to stay mentally engaged for long periods.

Rating:

1 = Minimal 10 = Optimal

Comments:

6. Emotional stability — how steady your emotions remain through the day.

Rating:

1 = Minimal 10 = Optimal

Comments:

7. Calm under pressure — your ability to stay composed during stress.

Rating:

1 = Minimal 10 = Optimal

Comments:

8. Productivity — how effectively you get things done.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION C — PHYSICAL PERFORMANCE & ENDURANCE

This section helps us correlate your muscular, cardiovascular, and motor performance with your athletic and metabolic gene pathways.

9. Overall physical strength — daily strength or training strength.

Rating:

1 = Minimal 10 = Optimal

Comments:

10. Muscle response — how well your muscles grow or adapt to training.

Rating:

1 = Minimal 10 = Optimal

Comments:

11. Endurance — ability to perform for long durations without fatigue.

Rating:

1 = Minimal 10 = Optimal

Comments:

12. High-intensity performance — explosive power for short bursts.

Rating:

1 = Minimal 10 = Optimal

Comments:

13. Speed & agility — how fast and responsive your movements feel.

Rating:

1 = Minimal 10 = Optimal

Comments:

14. Balance & stability — how grounded and controlled your movements feel.

Rating:

1 = Minimal 10 = Optimal

Comments:

15. Flexibility & mobility — freedom of movement without stiffness.

Rating:

1 = Minimal 10 = Optimal

Comments:

16. Joint & tendon strength — stability under load or activity.

Rating:

1 = Minimal 10 = Optimal

Comments:

17. Breathing efficiency — how well you breathe during effort.

Rating:

1 = Minimal 10 = Optimal

Comments:

18. Posture & movement alignment — correctness and ease of movement.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION D — RECOVERY & SLEEP

Recovery determines how effectively your body repairs. Sleep impacts metabolism, hormones, inflammation, and gene regulation.

19. Recovery after physical activity — speed and quality of recovery.

Rating:

1 = Minimal 10 = Optimal

Comments:

20. Sleep depth — how refreshing and restorative your sleep feels.

Rating:

1 = Minimal 10 = Optimal

Comments:

21. Sleep routine consistency — how regular your sleep-wake timings are.

Rating:

1 = Minimal 10 = Optimal

Comments:

22. Muscle soreness — how quickly soreness fades after training.

Rating:

1 = Minimal 10 = Optimal

Comments:

23. Ability to relax — how effectively your body enters rest mode.

Rating:

1 = Minimal 10 = Optimal

Comments:

24. Daily fatigue levels — how tired or energized you feel overall.

Overall Fatigue:

Morning Fatigue:

End of Day Fatigue:

1 = Minimal Energy 10 = Optimal Energy

Comments:

SECTION E — STRESS, MOTIVATION & EMOTIONAL HEALTH

Stress hormones and emotional stability are directly tied to epigenetic switches like COMT, BDNF, IL-6, and cortisol-regulating pathways.

25. Stress handling — how well you manage stress and anxiety.

Rating:

1 = Minimal 10 = Optimal

Comments:

26. Motivation & drive — consistency of internal motivation.

Rating:

1 = Minimal 10 = Optimal

Comments:

27. Mood positivity — how upbeat and emotionally uplifted you feel.

Rating:

1 = Minimal 10 = Optimal

Comments:

28. Resilience & pain tolerance — ability to push through challenges.

Rating:

1 = Minimal 10 = Optimal

Comments:

29. Capacity to handle daily load — mental/emotional load tolerance.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION F — NUTRITION, GUT HEALTH & METABOLISM

Your gut influences hormones, immunity, brain function, inflammation, and metabolic gene activity.

30. Digestion quality — smooth, consistent digestion.

Rating:

1 = Minimal 10 = Optimal

Comments:

31. Bloating or discomfort — freedom from bloating or heaviness.

Rating:

1 = Minimal 10 = Optimal

Comments:

32. Nutrient absorption — how well your body "utilizes" what you eat.

Rating:

1 = Minimal 10 = Optimal

Comments:

33. Hydration & electrolytes — how stable and hydrated you feel.

Rating:

1 = Minimal 10 = Optimal

Comments:

34. Body-weight stability — how balanced your weight feels.

Rating:

1 = Minimal 10 = Optimal

Comments:

35. Craving control — ability to manage cravings or overeating.

Rating:

1 = Minimal 10 = Optimal

Comments:

36. Overall eating habits — consistency of healthy choices.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION G — LONGEVITY, IMMUNITY & HEALTHSPAN

These indicators help us assess inflammation, oxidative stress, immune efficiency, and long-term health tendencies.

37. Immune strength — how often you fall ill or recover from illness.

Rating:

1 = Minimal 10 = Optimal

Comments:

38. Inflammation control — body heaviness, swelling, joint pain patterns.

Rating:

1 = Minimal 10 = Optimal

Comments:

39. Resistance to lifestyle diseases — how healthy you feel internally.

Rating:

1 = Minimal 10 = Optimal

Comments:

40. Aging wellness — skin, hair, energy, long-term vitality.

Rating:

1 = Minimal 10 = Optimal

Comments:

41. Overall internal organ health — how strong and balanced you feel.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION H — LIFESTYLE CONSISTENCY & DISCIPLINE

Your daily habits are the strongest contributors to epigenetic switching and long-term transformation.

42. Consistency of daily habits — morning/evening routines, structure.

Rating:

1 = Minimal 10 = Optimal

Comments:

43. Training/exercise consistency — frequency & discipline.

Rating:

1 = Minimal 10 = Optimal

Comments:

44. Work-life balance — ability to maintain healthy boundaries.

Rating:

1 = Minimal 10 = Optimal

Comments:

45. Overall daily energy & vitality — sustainable energetic flow.

Rating:

1 = Minimal 10 = Optimal

Comments:

46. Discipline & commitment toward goals — staying on track.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION I — PRODUCTIVITY & WORK PERFORMANCE

47. Day-long mental energy — avoiding dips or crashes.

Rating:

1 = Minimal 10 = Optimal

Comments:

48. Clarity & focus at work — ability to perform without clutter.

Rating:

1 = Minimal 10 = Optimal

Comments:

49. Motivation during work — internal drive to execute tasks.

Rating:

1 = Minimal 10 = Optimal

Comments:

50. Mid-day fatigue — energy drop in the afternoon.

Rating:

1 = Minimal 10 = Optimal

Comments:

51. Ability to complete daily responsibilities — execution quality.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION J — EMOTIONAL FULFILMENT & LIFE DIRECTION

52. Confidence in self & body — your sense of self-trust.

Rating:

1 = Minimal 10 = Optimal

Comments:

53. Emotional calmness — internal peace & steadiness.

Rating:

1 = Minimal 10 = Optimal

Comments:

54. Overall life satisfaction — feeling of fulfilment.

Rating:

1 = Minimal 10 = Optimal

Comments:

55. Self-awareness — connection with your mind & body.

Rating:

1 = Minimal 10 = Optimal

Comments:

56. Alignment with life goals — clarity of direction & purpose.

Rating:

1 = Minimal 10 = Optimal

Comments:

SECTION K — ADDITIONAL INFORMATION

Any specific concerns or symptoms you want us to know:

Any relevant health history:

Current supplements, medications, daily activities, lifestyle practices, and ongoing therapies:

We truly appreciate your time and honesty. Your inputs guide us in tailoring the most effective, personalized plan for your health, performance, and long-term wellbeing.

GENEHACK — PRE-CONSULTING QUESTIONNAIRE

(Optimized for Clarity, Engagement & Correlation)

BEFORE YOU BEGIN — WHY THIS QUESTIONNAIRE MATTERS

This questionnaire helps us:

SECTION A — PERSONAL INFORMATION

SECTION B — MIND & COGNITIVE PERFORMANCE

SECTION C — PHYSICAL PERFORMANCE & ENDURANCE

SECTION D — RECOVERY & SLEEP

SECTION E — STRESS, MOTIVATION & EMOTIONAL HEALTH

SECTION F — NUTRITION, GUT HEALTH & METABOLISM

SECTION G — LONGEVITY, IMMUNITY & HEALTHSPAN

SECTION H — LIFESTYLE CONSISTENCY & DISCIPLINE

SECTION I — PRODUCTIVITY & WORK PERFORMANCE

SECTION J — EMOTIONAL FULFILMENT & LIFE DIRECTION

SECTION K — ADDITIONAL INFORMATION