Wellness Questionnaire

Fill in the questionnaire below to find out how you rate your current wellness
and understand your readiness for change

I would like to make improvements in the following areas of my wellness

Energy levels

Stress management

Physical activity

Weight management

Eating habits

Relaxation

Sleep routine

Positive mindset

Healthy relationships

Job satisfaction

From the areas listed above, my priority area for change or improvement is:

How important is it to you that you make changes or improvements in your wellness (energy, stress, sleep, physical activity, mindset, life balance) at this time? On a scale of 1-10 (1= not very, 10 = very)

How confident are you that you can make changes or improvements in your wellness (energy, stress, sleep, physical activity, mindset, life balance) at this time? On a scale of 1-10 (1= not very, 10=very)

I maintain a comfortable balance between work, family, friends and self

The area that I would most like to have more time for is

First Name

Last Name

Email

Phone

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Wellness Questionnaire

Fill in the questionnaire below to find out how you rate your current wellness and understand your readiness for change

Fill in the questionnaire below to find out how you rate your current wellness
and understand your readiness for change