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Wellness Assessment

Are you tired of feeling out of shape and unhealthy? Are you ready to improve your health and your life? Start with this wellness assessment.

You have to know where you are to get where you're going. This assessment will help you determine where you are currently, so that you can reach your goal. The great part is, you don't have to do it alone.

Complete this assessment and let us know if you would like a FREE consultation to guide you along your way. 

Click the button below to start.

Start

Question 1 of 18

Full Name

Question 2 of 18

How dedicated are you now to reaching your full holistic health potential?

A

Very dedicated

B

Somewhat dedicated

C

I'm not sure yet

Question 3 of 18

When I awaken in the morning I feel...

A

Rested and ready for the day

B

Not bad

C

blah and sometimes still tired

Question 4 of 18

I typically get ____ hours of sleep. 

A

6-8 hours

B

4-5 hours

C

3 or less

Question 5 of 18

In general, I drink ____ of water.

A

a gallon or more

B

a few cups or bottles

C

too little to count

Question 6 of 18

When I go to the bathroom my urine is...

A

Clear

B

light yellow in color

C

dark yellow in color

Question 7 of 18

During the day I have ____ sweet snacks.

A

1 or less

B

2-3

C

too many to count

Question 8 of 18

In a day I have ____ sugary beverages. (including coffee with sugar)

A

1 or less

B

2-3

C

too many to count

Question 9 of 18

I usually have ___ servings of fruits and vegetables each day?

A

7 or more

B

4-6

C

3 or less

Question 10 of 18

I do some type of movement, workout, or physical activity...

A

5 or more times a week

B

2-3 times a week

C

1 or less times a week

Question 11 of 18

I have a stress management routine.

A

Yes

B

No

Question 12 of 18

My stress level is usually...

A

Pretty low

B

Up and down

C

Up or high

Question 13 of 18

Age range

A

Under 20

B

21-29

C

30-39

D

40-49

E

50-59

F

above 60

Question 14 of 18

I am ____ when it comes to my holistic health.

A

Very satisfied

B

Somewhat satisfied

C

Dissatisfied

Question 15 of 18

I am motivated and would like more direction on reaching my holistic health goals.

A

Yes

B

No

Question 16 of 18

I would like to apply for the free consultation.

A

Yes

B

Maybe later

C

No

COMPLIMENTARY CONSULTATION

Would you like a clear easy to follow plan to reach your holistic health goals? We can help. 

If you would like a complimentary consultation please include your phone number and email in the next box.

If you do not want a complimentary consultation type N/A in the next box.

Question 18 of 18

Email address and phone number for consultation. (Type N/A to decline consultations)

Confirm and Submit