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This is a questionnaire designed to identify areas of connection between dietary habits and spiritual practice. You do not need to eat a certain diet or have a certain spiritual faith to participate. The survey should not take more than 20 mins to complete. Don't spend too long pondering any one question. If for some reason you must stop in the middle, please submit your data and come back and complete it another time- just make sure to re-enter your name and start where you left off. Remember that your answers will remain completely confidential. Contact information will is only for verification purposes. It will definitely not be used for bulk e-mailings. Please aspire to be as honest in your answers as possible, no matter how much you may believe in the diet you consume, don't exaggerate its benefits because in the long run your honest input will be the most helpful to others. On questions about past habits, please think back to the time before you made any positive lifestyle habits, whether they be dietary, fitness related, or spiritual in nature. For questions on your current habits, average your consumption for the past year.

You should use your mouse or TAB key to move from field to field within the form. Some browsers may cause the form to be submitted prematurely if you use the ENTER key.

Name:
Email Address:
City:
State:

1. Of your current diet, estimate what % is fresh, raw/ uncooked vegan foods?

2. How long have you consumed a primarily raw vegan diet? Indicate months or years.

3. Did you first attempt to embrace a vegetarian or vegan diet before discovering raw foods?

4. Was there a serious health problem that lead you to improve your lifestyle?

5. If yes, please name/describe.

6. Has this condition cleared up as a result of your lifestyle changes?

7. Have you experienced a change in your weight?

8. Before making any positive lifestyle changes approximately how many times a year did you experience the common cold?

9. Now how many times a year do you experience the common cold?

10. Indicate change in any of the following health conditions since making positive lifestyle changes:

	---
	Heart problems improved
	Heart problems worsened
	respiratory improved
	respiratory worsened
	arthritis improved
	arthritis worsened
	digestive disorders improved
	digestive disorders worsened
	sugar metabolic (diabetes, hypoglycemia) improved
	sugar metabolic disorders worsened

11. Please indicate any of the following substances that you consumed regularly before making any positive lifestyle changes:

	Prescription drugs
	Over-the-counter medication
	Cigarettes
	Recreational drugs (include alcohol)
	Caffine or other stimulants
	Refined sugar
	Other refined foods-grains, oils, etc.
	Salt
	Spices
	Vitamins, herbs, and other supplements
	Prime time television, radio, or other form of mainstream media

12. Indicate any of the following substances that you currently consume:

	Prescription drugs
	Over-the-counter medication
	Cigarettes
	Recreational drugs (include alcohol)
	Caffine or other stimulants
	Refined sugar
	Other refined foods- grains, oils, etc.
	Spices
	Salt
	Vitamins, herbs, and other supplements
	Prime time television, radio, or other form of mainstream media

13. For the next series of questions estimate your consumption by calories, averaged for the past year. If you would eat something but super rarely put 1 or 2 %. What % is meat, chicken, or fish:

14. dairy and eggs:

15. beans (include sprouted)

16. grain products (include sprouted/dehydrated)

17. nuts and seeds (include nut butters and tahini):

18. root vegetables:

19. leafy green vegetables (include green sprouts):

20. fatty fruits (avocado, durian, young coconut)

21. All other fruits

22. Approximately what % of your diet is organically grown?

23. What % do you grow or harvest yourself? Include sprouting.

24. What percentage of meals do you consume mono-meals: i.e. one food per meal in its whole, raw, unprocessed state?

25. Does your diet change with the seasons? If it does indicate how.

	---
	No change
	More nuts and seeds in cold weather
	Seasonal produce availability
	More dried fruit ing cold weather
	More vegetables in cold weather
	More spicy foods in cold weather
	More sprouts in cold weather
	Other

26. Indicate all of the following emotions/ states of mind you experience on a daily basis:

	Samadhi/bliss
	Ability to Concentrate
	Distracted
	Anger
	Suicidal feelings
	Depression
	Joy
	Confusion
	Feeling grounded
	Feeling spacy
	Inclination to meditate
	Inner stillness, peaceful
	Sense of well-being
	Fear

27. Have you ever felt very close to a powerful, spiritual force that seemed to lift you out of yourself?

28. Have you ever had a moment of sudden spiritual/religious awakening or insight?

29. According to ancient scriptures there are five classifications of the mind. Please rate yourself honestly.

30. If you practice any form of yoga or meditation please complete the following section, otherwise skip to question 38. How long have you practiced yoga or other spiritual discipline?

31. Indicate which style/s you mainly practice:

32. How many days a week on average do you practice?

33. How long do you practice on average each of those days?

34. Do you include any of the following in your regular routine?

	Silent meditation
	Hatha yoga asanas
	Pranayama
	Teaching of yoga or meditation
	One pointed concentration
	Deep relaxation
	Guided visualization
	Internal cleansing practices
	Fasting
	Other

35. Have you noticed your ability to stick with your chosen dietary patterns improved by consistent practice?

36. How much does what you eat affect the quality of your practice?

37. Has your practice brought to awareness any specific food sensitivities/allergies? Indicate all that apply.

	No it hasn't
	Fried foods
	Cooked foods
	Meat
	Dairy
	Grains
	Refined foods
	Spices such as garlic, onions
	tomatoes
	Conventionally grown foods
	Hybridized or seedless fruits
	Genetically modified foods
	Artificial ingredients
	Other

38. Is there anything else you woud like to add about your experiences with raw foods and spiritual awaking?

Please feel free to share this survey with other raw fooders, especially individuals who have been eating a raw vegan diet for at least seven years. I wish I had a virtual piece of juicy ripe fruit to offer in gratitude for your participation.

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