Email

Any prior health conditions or medications taking?

Place of Work?

Employer's business name, if you you were referred here by your employer.

3) Work-Life Balance

Do you often feel guilty when taking time off or resting?

4) Work-Life Balance

How do you feel about your current work schedule?

5) Work-Life Balance

How would you describe your energy levels at the end of a typical workday?

6) Work-Life Balance

How do you prioritize self-care (exercise, relaxation, hobbies) during the workweek?

7) Work-Life Balance

What is one change you wish you could make to improve your work-life balance?

8) Current Health Status

How would you describe your overall health?

9) Current Health Status

How often do you experience low energy during the day?

11) Current Health Status

How often do you experience unexplained body aches, pain, or tension?

12) Current Health Status

Do you take any medications or supplements regularly?

13) Current Health Status

What is your biggest current health concern?

14) Stress Levels

How often do you feel stressed?

17) Stress Levels

How often do you practice stress-management techniques (exercise, meditation, therapy)?

18) Stress Levels

How does stress impact your productivity at work?

19) Stress Levels

How do you usually cope with stress?

20) Stress Levels

What is one thing that would help lower your stress?

21) Job Satisfaction

How do you feel about going to work each day?

22) Job Satisfaction

Do you feel valued and appreciated at your job?

23) Job Satisfaction

How often do you experience job-related stress?

24) Job Satisfaction

Do you feel your current job aligns with your long-term career goals?

25) Job Satisfaction

Have you considered looking for a new job in the last six months?

26) Job Satisfaction

How much control do you feel you have over your workload?

27) Job Satisfaction

Do you feel like your job contributes to your overall happiness?

28) Job Satisfaction

On a scale of 1-10, how satisfied are you with your job?

29) Job Satisfaction

How well do you get along with coworkers and management?

30) Job Satisfaction

If you could change one thing about your job to improve satisfaction, what would it be?

31) Nutritional Health

How often do you eat balanced meals (protein, healthy fats, fiber, and vegetables)?

33) Nutritional Health

How often do you consume processed or fast foods?

34) Nutritional Health

How much water do you drink daily?

35) Nutritional Health

Do you struggle with emotional or binge eating?

36) Nutritional Health

What is your biggest nutritional challenge?

37) Physical Health

How often do you engage in physical activity?

38) Physical Health

Do you experience any chronic pain or physical discomfort?

40) Physical Health

How often do you stretch or practice mobility exercises?

41) Physical Health

How would you describe your cardiovascular fitness (stamina and endurance)?

42) Physical Health

How often do you experience shortness of breath with basic activity?

43) Physical Health

How many hours per day do you spend sitting?

44) Physical Health

What is one fitness goal you’d like to achieve?

45) Mental Health

How often do you feel overwhelmed or emotionally exhausted?

46) Mental Health

How well do you sleep at night?

47) Mental Health

How often do you experience feelings of anxiety or excessive worry?

48) Mental Health

Do you ever struggle with feelings of sadness, hopelessness, or depression?

50) Mental Health

How often do you engage in activities that bring you joy?

51) Mental Health

How often do you feel socially connected and supported?

52) Mental Health

Do you have any professional mental health support?

53) Mental Health

What is one thing that improves your mental well-being when you're struggling?

54) Life Satisfaction

How satisfied are you with your overall quality of life?

55) Life Satisfaction

Do you feel like you are living in alignment with your values and passions?

56) Life Satisfaction

How often do you feel a sense of purpose in your daily life?

57) Life Satisfaction

Do you feel financially secure and in control of your future?

58) Life Satisfaction

How do you feel about your personal relationships (friends, family, partner)?

59) Life Satisfaction

How often do you take time for personal growth (reading, learning, self-improvement)?

60) Life Satisfaction

How well do you balance work, relationships, and personal time?

61) Life Satisfaction

If you could change one area of your life right now, which would it be?

62) Life Satisfaction

What is one thing that would make your life significantly better right now?