Name

First Name

Last Name

PHQ-9: In the last 30 days are you bothered by any of the following problems?

1. Having little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

3. Trouble falling asleep or staying asleep, or sleeping too much

4. Feeling tired or having little energy

5. Poor appetite or overeating

6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down

7. Trouble concentrating on things, such as reading the newspaper or watching television

8. Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual

9. Thoughts that you would be better off dead or of hurting yourself in some way

10. If you checked off any problems, how difficult have these problems made it for you to work, take care of things at home, or get along with other people?

1. Not at all difficult 2. Somewhat difficult 3. Very difficult 4. Extremely difficult

GAD-7 In the last 30 days are you bothered by the following ?

1. Feeling nervous, anxious, or on edge?

2. Not being able to stop or control worrying?

3. Worrying too much about different things

4. Trouble relaxing?

5. Being so restless that it is hard to sit still?

6. Becoming easily annoyed or irritable?

7. Feeling afraid as if something awful might happen?

8. If you checked off any problems, how difficult have these problems made it for you to work, take care of things at home, or get along with other people?

1. Not at all difficult 2. Somewhat difficult 3. Very difficult 4. Extremely difficult

Universal Pain Assessment Tool:

What is your current level of pain?

0-1 No Pain 2-3 Mild Pain, can be ignored 3-4 Moderate Pain, interferes with tasks 5-6 Moderate Pain, interferes with concentration 7-8 Severe Pain, interferes with basic needs 9-10 Worst Pain Possible, bedrest required

Officer or Enlisted

If you served in the Armed Forces, were you an officer or were you enlisted. Or both?

Do you currently have a rating for PTSD

If you have a PTSD rating or believe you may have PTSD

Education Level

What Pivotal Fitness Location Do You Exercise At?

Please tell us which gym you are using?

Thank you for completing the intake surveys. We will be in contact with you shortly to provide your membership credentials at Pivotal Fitness.

If you do not receive an email within 24 hours contact me directly: dan@operationvetfit.org

For Research Event Participants: Feel free to invite your friends that are participating in this event to also join us. You can do so by sharing this link with them: http://www.operationvetfit.org/ruggedresearch

Thanks for your help and participation in this groundbreaking research.