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Health Assessment Form

Health Assessment Form

  • What’s Your Stress Assessment

    The good news is: Your mindset can always change, we just need to change a few beliefs you have. How you feel and live your life reflects your level of mental stress. How do you feel when you get up in the morning? How much energy and mental focus do you maintain throughout the day? Does mental or physical stress slow you down and keep you from doing what you want to do and being the person you want to be?? Looking for more clarity, peace and passion in your life? Let's not be silly, there is no magic pill to give one peace of mind and total body wellness. But we can utilize the best tools available to us to help us restore the mind/ body, and dramatically change the way in which we experience our daily walk on this planet. Every day does not have to be hard... lowering stress and being at ease is a wonderful thing! So please assess your stress level. Continue below to take our 5 minute health assessment so we have a baseline to work from and knowledge of what will be your most impactful place to start...
  • Rate yourself for each category using the rating system below to score yourself.

    0 to 3: Low energy, feeling overwhelmed, not functioning well, poor food choices, frequent use of stimulants.

    4 to 7: Feeling/performing OK; some healthy choices, room to improve, some use of stimulants.

    8 to 10: Feeling/performing well, making healthy choices, steady improvement, no use of stimulants.

  • Vitality Indicator

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    (Based on the number of cups per day - the more you drink the lower your score)