1234567891011121314151617181920212223242526272829 Holistic Wellness Assessment Instructions: Answer each question honestly based on your current lifestyle and habits. Use the scoring guide at the end to assess your overall wellness. 1 / 29 Category: Uncategorized What is your first and last name? Check 2 / 29 Category: Uncategorized What is your email address? Check 3 / 29 Category: Physical How often do you engage in physical activity? Select an answerRarely or neverOccasionally (1-2 times per week)Regularly (3-4 times per week)Consistently (5 or more times per week) 4 / 29 Category: Physical How would you describe your current level of flexibility and mobility? Select an answerLimitedModerateGoodExcellent 5 / 29 Category: Physical How well do you feel you understand how your body responds to exercise and what exercises best fuel your body? Select an answerLimited understandingModerate understandingGood understandingExcellent understanding 6 / 29 Category: Physical How frequently do you experience pain that limits your ability to engage in life activities? Select an answerConsistentlyRegularlyOccasionallyRarely or Never 7 / 29 Category: Physical What is your level of satisfaction with your strength (to do the things you want/need to do)? Select an answerLow - I feel weak relative to what I want to doModerate - I feel like I can do most of what I want/need to doGood - I manage my daily activities but don’t feel particularly strongExcellent - I feel very strong and capable of doing everything I want to do 8 / 29 Category: Physical What is your level of satisfaction with your overall fitness? Select an answerLow - I am not happy with my current level of fitness at allModerate - I feel okay about it, but could do betterGood - I feel like I’m doing what I probably can realistically do and feel good about itExcellent - I prioritize my fitness and feel really great about where I am 9 / 29 Category: Nutrition How would you rate your understanding of your body’s unique nutritional needs? Select an answerLimited understandingModerate UnderstandingGood understandingExcellent Understanding 10 / 29 Category: Nutrition How would you rate the balance of your daily meals? Select an answerMostly processed foodsSome whole foods, but room for improvementBalanced with a mix of whole foodsMostly whole, nutrient-dense foods 11 / 29 Category: Nutrition How often do you consume sugary or highly processed snacks? Select an answerFrequentlyOccasionallyRarelyNever 12 / 29 Category: Nutrition How often do you experience abdominal pain/bloating, diarrhea, gas, heartburn or upset stomach after eating? Select an answerFrequentlyOccasionallyRarelyNever 13 / 29 Category: Nutrition How many glasses of water do you typically drink in a day? Select an answerLess than 4 glasses4-6 glasses7-8 glassesMore than 8 glasses 14 / 29 Category: Nutrition How many glasses of alcohol do you typically have in a week? Select an answer6+3-60-3Don't drink at all 15 / 29 Category: Nutrition How many cups of coffee or caffeinated beverages do you have in a day? Select an answer4+2-40-2Don't drink caffeine 16 / 29 Category: Sleep How would you describe the quality of your sleep? Select an answerPoorFairGoodExcellent 17 / 29 Category: Sleep How many hours of sleep do you usually get each night? Select an answerLess than 4 hours4-6 hours6-8 hoursMore than 8 hours 18 / 29 Category: Sleep How frequently do you typically wake up in the middle of the night? Select an answerMultiple times1-2 timesI don't wake up in the middle of the night 19 / 29 Category: Social/Emotional How often do you engage in social activities or connect with friends and family? Select an answerRarely or neverOccasionallyRegularlyConsistently 20 / 29 Category: Social/Emotional How often do you engage in something that you enjoy doing? (hobbies, self care, down time) Select an answerRarely or neverOccasionallyRegularlyConsistently 21 / 29 Category: Social/Emotional How often do you feel depressed or lonely? Select an answerFrequently - mostly every dayRegularly - most daysOccasionallyRarely or never 22 / 29 Category: Social/Emotional How often do events from your past affect your mood or ability to engage in life how you’d like to? Select an answerFrequently - mostly every dayRegularly - most daysOccasionallyRarely or never 23 / 29 Category: Social/Emotional How often do you feel proud of who you are and where you are in life? Select an answerRarely or neverOccasionallyRegularlyConsistently 24 / 29 Category: Social/Emotional How would you rate your support system for your emotional needs (people to talk to)? Select an answerPoorFairGoodExcellent 25 / 29 Category: Social/Emotional How would you rate your coping skills to handle stress and/or adversity? Select an answerPoorFairGoodExcellent 26 / 29 Category: External/Environmental How would you rate your support system for logistical needs (sharing the load)? Select an answerPoorFairGoodExcellent 27 / 29 Category: External/Environmental How often do you feel very stressed or anxious about life/work requirements? Select an answerConsistently - all day, most daysRegularly- most daysOccasionallyRarely or never 28 / 29 Category: External/Environmental How often do you feel very stressed or anxious about money? Select an answerConsistently - all day, most daysRegularly- most daysOccasionallyRarely or never 29 / 29 Category: External/Environmental How satisfied are you in your relationship (with partner, spouse) Select an answerNot happy at allWe’re okay but it’s been betterAlways room for improvement but overall pretty happyWe’re thrivingN/A Your score is 0% Restart quiz
