Health Assessment
Create Your Own Custom Health Assessments:
Health Assessment:
How To Design Your Own
Our Health Assessment includes 8 customizable sections designed to gather the most relevant information from your clients. Each section includes a mix of multiple-choice, scale-based, and open-ended questions that you can tailor to your needs. We recommend using Google Forms for easy creation and management of your health assessments. For optimal results, aim for about 85-90% multiple-choice questions, 10-20% scale-based questions, and only 5-10% open-ended questions.
This assessment serves as a valuable tool to help you gather crucial data from potential leads. Not only does it provide you with insights into your prospects' needs, but it also positions you as a trusted resource when you present this data to businesses and partners. The health assessment is a powerful entry point into building relationships and securing new clients, allowing you to tailor your offerings based on the detailed insights you've gathered. Choose the questions that best fit your practice and let this tool work for you!
1) Work-Life Balance
These questions assess how well the individual manages professional and personal responsibilities.
1. How often do you feel like you have enough time for personal activities outside of work?
🔘 Almost always – I can easily balance work and personal life without feeling rushed.
🔘 Often – I usually have enough time but occasionally feel overwhelmed.
🔘 Sometimes – I have difficulty maintaining a balance and often sacrifice personal time.
🔘 Rarely – I struggle to find time for myself due to work demands.
🔘 Never – My work completely consumes my time, leaving little to no room for personal activities.
2. On a typical workday, how many hours do you spend on work-related tasks, including emails and calls?
🔘 Less than 6 hours
🔘 6-8 hours
🔘 8-10 hours
🔘 10-12 hours
🔘 More than 12 hours
3. Do you often feel guilty when taking time off or resting?
🔘 Never – I fully disconnect when I take time off.
🔘 Rarely – I occasionally feel guilty but manage to enjoy my time off.
🔘 Sometimes – I feel guilty and check emails or messages when off.
🔘 Often – I struggle to disconnect and frequently think about work.
🔘 Always – I feel like I can’t take time off without consequences.
4. How often do you have to work outside of regular work hours (evenings, weekends, holidays)?
🔘 Never – I strictly maintain work boundaries.
🔘 Occasionally – Only during peak work periods.
🔘 Sometimes – At least once a week.
🔘 Frequently – Almost every day.
🔘 Always – My job demands I’m available at all times.
5. How do you feel about your current work schedule?
🔘 Perfect – It gives me flexibility and balance.
🔘 Acceptable – I have a routine that mostly works for me.
🔘 Challenging – I often struggle to balance work and life.
🔘 Overwhelming – I feel like I have no control over my time.
6. Do you take regular breaks during the workday?
🔘 Yes, I take breaks every hour.
🔘 Yes, but only once or twice during the day.
🔘 Rarely – I usually work through without stopping.
🔘 Never – I can’t afford to take breaks.
7. How would you describe your energy levels at the end of a typical workday?
🔘 Energized – I feel good and have energy left for personal activities.
🔘 Neutral – I feel okay but not particularly energized.
🔘 Drained – I feel tired but can still manage personal tasks.
🔘 Exhausted – I have no energy left for anything else.
8. On a scale from 1-10, how satisfied are you with your current work-life balance?
(1 = Completely Unsatisfied, 10 = Perfect Balance)
9. How do you prioritize self-care (exercise, relaxation, hobbies) during the workweek?
🔘 Always – I schedule and prioritize these activities.
🔘 Often – I make time for them regularly.
🔘 Sometimes – I try, but work often gets in the way.
🔘 Rarely – I struggle to find time.
🔘 Never – I don’t prioritize self-care.
10. Open-Ended: What is one change you wish you could make to improve your work-life balance?
2) Current Health Status
These questions gather information on physical and mental well-being, common ailments, and energy levels.
1. How would you describe your overall health?
🔘 Excellent – No health issues, high energy, and feel great.
🔘 Good – Some minor health concerns but generally feel well.
🔘 Fair – I have a few ongoing health issues that impact daily life.
🔘 Poor – I struggle with multiple health problems that affect my daily activities.
2. Do you experience any of the following common ailments regularly? (Select all that apply)
⬜ Fatigue or low energy
⬜ Headaches or migraines
⬜ Digestive issues (bloating, constipation, acid reflux, IBS)
⬜ Joint pain or stiffness
⬜ Sleep disturbances or insomnia
⬜ Anxiety or depressive symptoms
⬜ Frequent colds or low immunity
⬜ High blood pressure or heart-related concerns
⬜ None of the above
3. How many hours of sleep do you get on an average night?
🔘 7-9 hours (optimal)
🔘 5-6 hours (somewhat inadequate)
🔘 Less than 5 hours (very inadequate)
🔘 More than 9 hours (potentially excessive)
4. How often do you experience low energy during the day?
🔘 Never – I feel energized throughout the day.
🔘 Occasionally – I have some dips in energy.
🔘 Regularly – I feel sluggish most afternoons.
🔘 Constantly – I struggle to stay awake and alert.
5. How often do you experience unexplained body aches, pain, or tension?
🔘 Never
🔘 Occasionally
🔘 Weekly
🔘 Daily
6. Do you take any medications or supplements regularly?
🔘 No, I don’t take any.
🔘 Yes, for general health (vitamins, supplements).
🔘 Yes, for a specific medical condition.
🔘 Yes, a mix of both.
7. How often do you engage in physical activity?
🔘 Daily
🔘 A few times per week
🔘 Occasionally
🔘 Rarely or never
8. On a scale of 1-10, how would you rate your daily energy levels?
(1 = Always exhausted, 10 = Highly energized)
9. Have you experienced significant weight changes in the last 6 months?
🔘 No change
🔘 Gained weight unintentionally
🔘 Lost weight unintentionally
🔘 I have actively worked on weight management
10. Open-Ended: What is your biggest current health concern?
3) Stress Levels
These questions assess both the causes and effects of stress on daily life.
1. How often do you feel stressed?
🔘 Rarely – I manage stress well.
🔘 Occasionally – I feel stressed but can handle it.
🔘 Frequently – Stress impacts me regularly.
🔘 Constantly – I feel overwhelmed daily.
2. What are your main sources of stress? (Select all that apply)
⬜ Work-related pressure
⬜ Financial concerns
⬜ Family responsibilities
⬜ Health concerns
⬜ Relationships or social pressures
⬜ Personal expectations/perfectionism
⬜ None of the above
3. How does stress usually manifest for you?
🔘 Headaches, muscle tension, or body aches
🔘 Anxiety, nervousness, or difficulty relaxing
🔘 Irritability or mood swings
🔘 Trouble sleeping or fatigue
🔘 Digestive issues (bloating, upset stomach)
🔘 I don’t experience physical effects from stress
4. How well do you manage stress?
🔘 Very well – I have strong coping strategies.
🔘 Somewhat well – I manage stress but have bad days.
🔘 Poorly – I struggle to cope effectively.
🔘 Not at all – I feel completely overwhelmed.
5. How often do you practice stress-management techniques (exercise, meditation, therapy)?
🔘 Daily
🔘 Weekly
🔘 Occasionally
🔘 Never
6. On a scale of 1-10, how would you rate your current stress levels?
(1 = No stress, 10 = Overwhelmed daily)
7. Do you find it difficult to relax and unwind?
🔘 Never
🔘 Occasionally
🔘 Often
🔘 Always
8. How does stress impact your productivity at work?
🔘 No impact
🔘 Slight impact
🔘 Moderate impact
🔘 Major impact
9. How do you usually cope with stress?
🔘 Healthy outlets (exercise, therapy, hobbies)
🔘 Distracting activities (TV, social media, gaming)
🔘 Unhealthy coping (overeating, alcohol, avoiding problems)
🔘 I don’t have a coping strategy
10. Open-Ended: What is one thing that would help lower your stress?
4) Job Satisfaction
(Understanding if they associate happiness with their job, look forward to it, want to find a new job, etc.)
1. How do you feel about going to work each day?
🔘 Excited – I love my job and look forward to it.
🔘 Content – I enjoy my work but have some challenges.
🔘 Neutral – It’s just a job; I don’t love or hate it.
🔘 Unhappy – I feel drained and unmotivated most days.
🔘 Miserable – I dread going to work.
2. Do you feel valued and appreciated at your job?
🔘 Always – My contributions are recognized and appreciated.
🔘 Often – I receive some recognition but could use more.
🔘 Sometimes – Occasionally, but not consistently.
🔘 Rarely – I don’t feel appreciated for my work.
🔘 Never – I feel completely undervalued.
3. How often do you experience job-related stress?
🔘 Never – My job is low-stress and well-balanced.
🔘 Occasionally – Some stressful moments, but manageable.
🔘 Frequently – Stress is a regular part of my work.
🔘 Constantly – My job feels overwhelming.
4. Do you feel your current job aligns with your long-term career goals?
🔘 Yes – This is exactly what I want to be doing.
🔘 Somewhat – I’m learning skills that will help me in the future.
🔘 Not really – I don’t see a clear path forward.
🔘 No – I want to change careers soon.
5. Have you considered looking for a new job in the last six months?
🔘 No, I’m happy where I am.
🔘 Yes, but I haven’t actively searched.
🔘 Yes, I’ve started looking for new opportunities.
🔘 Yes, I am actively applying and interviewing.
6. How much control do you feel you have over your workload?
🔘 Full control – I manage my tasks well.
🔘 Some control – I have input, but deadlines can be demanding.
🔘 Little control – I’m often overwhelmed with assignments.
🔘 No control – My workload feels unmanageable.
7. Do you feel like your job contributes to your overall happiness?
🔘 Yes – My job brings me joy and fulfillment.
🔘 Somewhat – I enjoy some parts, but it’s not my passion.
🔘 No – My job feels like a source of stress and unhappiness.
8. On a scale of 1-10, how satisfied are you with your job?
(1 = Completely dissatisfied, 10 = Extremely satisfied)
9. How well do you get along with coworkers and management?
🔘 Very well – I have great relationships with my team.
🔘 Okay – I get along, but I keep it professional.
🔘 Poorly – There’s tension or lack of connection.
🔘 Not at all – I have workplace conflicts.
10. Open-Ended: If you could change one thing about your job to improve satisfaction, what would it be?
5) Nutritional Health
(Understanding eating habits, deficiencies, hydration, and meal balance.)
1. How often do you eat balanced meals (protein, healthy fats, fiber, and vegetables)?
🔘 Always – Every meal is well-balanced.
🔘 Often – I try, but sometimes I fall short.
🔘 Occasionally – I have some healthy meals, but not regularly.
🔘 Rarely – My diet is often unbalanced.
2. Do you experience any of the following food-related issues? (Select all that apply)
⬜ Bloating, gas, or stomach discomfort
⬜ Acid reflux or heartburn
⬜ Blood sugar crashes (fatigue, dizziness after eating)
⬜ Sugar cravings or dependency
⬜ Difficulty maintaining a healthy weight
⬜ No issues
3. How many servings of fruits and vegetables do you eat daily?
🔘 5+ servings (great intake)
🔘 3-4 servings (moderate intake)
🔘 1-2 servings (low intake)
🔘 None or very rarely
4. How often do you consume processed or fast foods?
🔘 Never or rarely
🔘 A few times per month
🔘 A few times per week
🔘 Daily
5. How much water do you drink daily?
🔘 8+ cups (fully hydrated)
🔘 5-7 cups (moderate hydration)
🔘 3-4 cups (low hydration)
🔘 Less than 3 cups (dehydrated)
6. How often do you eat meals mindfully (without distractions like TV, phone, or work)?
🔘 Always – I focus on my meals and eat without distractions.
🔘 Often – I try to be mindful but sometimes multitask.
🔘 Occasionally – I eat while watching TV or scrolling on my phone.
🔘 Rarely – I almost always eat distracted.
7. Do you struggle with emotional or binge eating?
🔘 Never – I have a healthy relationship with food.
🔘 Occasionally – I sometimes eat emotionally.
🔘 Frequently – Emotional eating is a pattern for me.
🔘 Constantly – I feel like I have little control over my eating habits.
8. On a scale of 1-10, how would you rate your overall nutrition?
(1 = Very poor, 10 = Excellent)
9. Do you take any vitamins or supplements?
🔘 No
🔘 Yes, occasionally
🔘 Yes, daily
10. Open-Ended: What is your biggest nutritional challenge?
6) Physical Health
(Understanding fitness levels, movement habits, and bodily function.)
1. How often do you engage in physical activity?
🔘 Daily (30+ minutes of movement)
🔘 A few times per week
🔘 Occasionally (once per week or less)
🔘 Rarely or never
2. Do you experience any chronic pain or physical discomfort?
🔘 No, I feel great.
🔘 Occasionally – Minor aches, but nothing serious.
🔘 Regularly – I have pain that impacts my activities.
🔘 Constantly – Pain significantly affects my daily life.
3. Do you have any of the following mobility issues? (Select all that apply)
⬜ Limited flexibility
⬜ Difficulty walking long distances
⬜ Joint pain or stiffness
⬜ Poor posture or back pain
⬜ None of the above
4. How often do you stretch or practice mobility exercises?
🔘 Daily
🔘 A few times per week
🔘 Occasionally
🔘 Rarely or never
5. How would you describe your cardiovascular fitness (stamina and endurance)?
🔘 Excellent – I can exercise for long periods without fatigue.
🔘 Good – I have decent endurance but could improve.
🔘 Fair – I get tired easily.
🔘 Poor – I struggle with even light activity.
6. How often do you experience shortness of breath with basic activity?
🔘 Never
🔘 Occasionally
🔘 Frequently
🔘 Always
7. On a scale of 1-10, how strong and capable do you feel in your body?
(1 = Very weak, 10 = Strong and capable)
8. How do you feel about your current fitness level?
🔘 Very satisfied
🔘 Somewhat satisfied
🔘 Neutral
🔘 Dissatisfied
9. How many hours per day do you spend sitting?
🔘 Less than 3 hours
🔘 3-6 hours
🔘 7-9 hours
🔘 10+ hours
10. Open-Ended: What is one fitness goal you’d like to achieve?
7) Mental Health
(Understanding emotional well-being, coping mechanisms, and mental resilience.)
1. How often do you feel overwhelmed or emotionally exhausted?
🔘 Never – I manage stress well.
🔘 Occasionally – I have some tough days but generally cope well.
🔘 Frequently – I often feel emotionally drained.
🔘 Constantly – I feel overwhelmed nearly every day.
2. How well do you sleep at night?
🔘 Excellent – I wake up refreshed and well-rested.
🔘 Good – I sleep well most nights but occasionally wake up tired.
🔘 Fair – I have trouble falling or staying asleep some nights.
🔘 Poor – I rarely feel rested, and my sleep is inconsistent.
3. How often do you experience feelings of anxiety or excessive worry?
🔘 Never – I feel calm and in control.
🔘 Occasionally – I worry sometimes, but it doesn’t interfere with my life.
🔘 Frequently – Anxiety affects me on a regular basis.
🔘 Constantly – I struggle with severe or chronic anxiety.
4. How do you usually cope with stress? (Select all that apply)
⬜ Exercise or physical activity
⬜ Meditation or mindfulness practices
⬜ Talking to friends or family
⬜ Engaging in hobbies or creative activities
⬜ Unhealthy habits (overeating, drinking, smoking, etc.)
⬜ Avoiding or ignoring stress
5. Do you ever struggle with feelings of sadness, hopelessness, or depression?
🔘 Never – I feel emotionally stable.
🔘 Occasionally – I experience occasional low moods but can manage them.
🔘 Frequently – I have persistent sadness or lack of motivation.
🔘 Constantly – I struggle with deep feelings of depression.
6. How often do you engage in activities that bring you joy?
🔘 Daily – I regularly make time for enjoyable activities.
🔘 A few times per week – I try to prioritize things I enjoy.
🔘 Occasionally – I get busy and don’t always make time.
🔘 Rarely or never – I struggle to find joy in activities.
7. On a scale of 1-10, how would you rate your overall mental health?
(1 = Very poor, 10 = Excellent)
8. How often do you feel socially connected and supported?
🔘 Always – I have strong, supportive relationships.
🔘 Often – I have a solid support system but could use more connection.
🔘 Sometimes – I feel lonely or disconnected at times.
🔘 Rarely – I often feel isolated and unsupported.
9. Do you have any professional mental health support?
🔘 Yes – I see a therapist, counselor, or coach regularly.
🔘 Occasionally – I have seen a professional but not consistently.
🔘 No – I have never sought professional mental health support.
10. Open-Ended: What is one thing that improves your mental well-being when you're struggling?
8) Life Satisfaction
(Understanding overall happiness, fulfillment, and personal alignment with goals.)
1. How satisfied are you with your overall quality of life?
🔘 Very satisfied – I love my life and feel fulfilled.
🔘 Somewhat satisfied – I have a good life but see areas for improvement.
🔘 Neutral – I don’t love or hate my life, it’s just okay.
🔘 Dissatisfied – I often feel unfulfilled and unhappy.
🔘 Very dissatisfied – I feel like my life needs a major change.
2. Do you feel like you are living in alignment with your values and passions?
🔘 Yes – I’m pursuing what truly matters to me.
🔘 Somewhat – I’m working towards it, but I could be doing more.
🔘 Not really – I often feel like I’m stuck or off track.
🔘 No – I feel disconnected from what I truly want in life.
3. How often do you feel a sense of purpose in your daily life?
🔘 Daily – I have a strong sense of meaning and direction.
🔘 Often – I feel purpose but sometimes lose sight of it.
🔘 Occasionally – I struggle to find meaning in my day-to-day life.
🔘 Rarely or never – I feel like I lack direction.
4. Do you feel financially secure and in control of your future?
🔘 Yes – I’m in a great financial position and feel secure.
🔘 Mostly – I manage well but sometimes feel stressed.
🔘 Not really – Finances cause me significant stress.
🔘 No – I constantly worry about money and financial stability.
5. How do you feel about your personal relationships (friends, family, partner)?
🔘 Very satisfied – I have deep and meaningful connections.
🔘 Somewhat satisfied – I have good relationships but want to improve them.
🔘 Neutral – My relationships feel okay but could be stronger.
🔘 Dissatisfied – I feel disconnected from my relationships.
6. How often do you take time for personal growth (reading, learning, self-improvement)?
🔘 Daily – I make it a priority.
🔘 Often – I try to focus on growth when I can.
🔘 Occasionally – I’d like to do more but struggle with consistency.
🔘 Rarely – I don’t focus on personal development much.
7. On a scale of 1-10, how happy are you with your life overall?
(1 = Completely unhappy, 10 = Extremely happy)
8. How well do you balance work, relationships, and personal time?
🔘 Very well – I prioritize all areas of my life effectively.
🔘 Moderately well – I balance things, but some areas need more attention.
🔘 Poorly – I struggle to maintain a good balance.
🔘 Very poorly – My life feels chaotic and unbalanced.
9. If you could change one area of your life right now, which would it be?
🔘 Career & Work
🔘 Relationships
🔘 Health & Well-being
🔘 Finances
🔘 Personal Growth
🔘 Nothing – I’m happy with my life as it is.
10. Open-Ended: What is one thing that would make your life significantly better right now?