Apply for Z4 Protocol Program Habits

First Name (required)

Last Name (required)

Your Email (required)

Tel number (required)

Eating Habits (required)

—Please choose an option—All foods mixedAll foods primarily carbsAll foods primarily meatAll foods primarily vegetablesVegetarian with fishVegetarian strictVeganDiabeticRaw - VeganKosher or halal
Gluten - FreeI eat lots of sweetsI eat lots of diaryExtra snacksI eat lots of extra fruits

Eating Timing Habits (required)

—Please choose an option—Regular 1 meal/dayRegular 2 meals/dayRegular 3 meals/dayRegular 4 meals/dayRegular 5 or more meals/dayIrregular
Intermittent fasting up to 12hIntermittent fasting 12-16hI eat late at nightI eat many snacksI skip breakfastI don't eat after 6pmI over eat each mealI'm hungry after meal

Drinking Habits Water, Alcohol, others(required)

—Please choose an option—I drink up to 1L water per dayI drink up to 2L of water per dayI drink more than 2L of water per day
—Please choose an option—I don't drink alcoholI drink alcohol once per weekI drink alcohol twice per weekI drink alcohol three times per weekI drink alcohol 4 or more times per week
I use distilled waterI use filtered waterWe have drinking tap water1 or more energy drinks/day2 or more soft drinks/day

Smoking habits (required)

—Please choose an option—Non SmokerSmoking up to 5 cigarettes per daySmoking up to 10 cigarettes per daySmoking up to 20 cigarettes per daySmoking more than 20 cigarettes per day

Sleeping habits (required)

—Please choose an option—regularly around 8hregularly more than 8hregularly 6-8hregularly less than 6hirregularly less than 6hirregularly more than 6h

Physical exercise (required)

—Please choose an option—sport intensity more than 3x/weeksport intensity 3x/weeksport intensity 2x/weeksport intensity 1x/weekLow intensity (ie walking) 30min+/dayLow intensity (ie walking) 3x/weekLow intensity (ie walking) 2x/weekLow intensity more than 45 min (ie walking) 1x/weekOnce in a while irregular
I go to fitness/gymI practice outside more than 1/weekI do yoga in studioI practice at homeI practice with weights

Mental or spiritual and breathing exercises (required)

—Please choose an option—Meditate or visualize twice a dayMeditate or visualize every dayMeditate or visualize 3x/weekMeditate or visualize 2x/weekMeditate or visualize 1x/weekOnce in a while irregularNever
—Please choose an option—Breathing exercise (20min or more) twice a dayBreathing exercise (20min or more) every dayBreathing exercise (20min or more) 3x/weekBreathing exercise (20min or more) 2x/weekBreathing exercise (20min or more) 1x/weekOnce in a while irregularNever
I overview my day before sleepI wake up without alarmI often visualize my goalsI'm often afraid for my healthI meditate to some gods/masters/teachersI go to church regularly or prayI bless food before eatingI express my gratitude internally for lifeI'm happy with my bodyI'm happy with my workI'm happy with my familyI enjoy my hobbiesI often feel fulfilled

Emotions and stress handling (required)

—Please choose an option—Get over emotional more than 2/dayGet over emotional every dayGet over emotional 3x/weekGet over emotional 2x/weekGet over emotional 1x/weekGet over emotional once a monthNever
—Please choose an option—Feel stressed every dayFeel stressed 3-5x/weekFeel stressed 1-2x/weekFeel stressed once in a whileNever
Get depressed 1x/weekOften feel overwhelmed with workOften feel overwhelmed with familyOften feel overwhelmed with people around meGet in arguments frequentlyFeel as a victim oftenFeel guilty when others point outFeel self guiltNot happy with bodyFeel criticized by others

News, Learning and reading (required)

—Please choose an option—Watch TV mostly films/series more than 2h/dayWatch TV mostly news more than 2h/dayWatch TV mostly documentaries/nature more than 2h/dayWatch TV mostly films/series 1-2h/dayWatch TV mostly news 1-2h//dayWatch TV mostly documentaries/nature 1-2h//dayWatch TV mostly films/series less than 1h/dayWatch TV mostly news less than 1h/dayWatch TV mostly documentaries/nature less than 1h/dayWatch TV every once in a whileNever
—Please choose an option—Reading casual books more than 2h/dayReading knowledge books/online more than 2h/daySocial media more than 2h/dayReading casual books 1-2h/dayReading knowledge books/online 1-2h//daySocial media 1-2h//dayReading casual books less than 1h/dayReading knowledge books/online less than 1h/daySocial media less than 1h/dayRead books or online every once in a whileNever read
Always updated with politicsAlways updated with sportsAlways updated with newsFollow conspiracy theoriesFollow health subjectsFollow a lot about my hobbiesI mostly use YouTubeI mostly readPolitics ignites my passion/angerI like to post or write reviews a lotInvolved with some projects ie. Wikipedia

Phone usage (required)

—Please choose an option—Use mobile mostly for calling/texting more than 2h/dayUse mobile mostly for social media more than 2h/dayUse mobile mostly for work/email/reading more than 2h/dayUse mobile mostly for calling/texting 1-2h/dayUse mobile mostly for social media 1-2h//dayUse mobile mostly for work/email/reading 1-2h//dayUse mobile mostly for calling/texting less than 1h/dayUse mobile mostly for social media less than 1h/dayUse mobile mostly for work/email/reading less than 1h/dayUse mobile rarely, only when neededNever
Read news on mobileAlways use headsetsAlways use Bluetooth headsetAlways use speaker phoneUse mobile while driving (hands-free)Carry mobile in front pants pocketCarry mobile in pocket close to heartUse ariplane mode at night or keep it away from bedTaking lots of photos/video with mobileMostly chat with instant messaging via mobile