• Wellness Assesment

  • A Few Details...

  •  -

  • Exercise Stuff

  • Do you exercise? How many times per week?
  • Specify type

  • Medical Stuff

  • Are you currently under a doctor or medical professional's care?
  • Do you smoke/ use tobacco?
  • Do you drink? How many drinks per week?
  • Do you use sunscreen daily?

  • Nutrition

  • How many cups of coffee or caffeinated beverages do you normally consume daily?
  • How many 8 oz. glasses of water do you normally drink daily?
  • Are you getting 3-5 servings of fruits and vegetables/day?
  • Do you usually:
  • Wouldyou say your diet is balanced

  • Stress, Sleep, and Leisure

  • How often do you feel stressed?
  • What do you consider the main source of your stress?

  • What activities do you do for fun or relaxation and how many times/week?

  • Have you ever sought help to manage your stress
  • If so, Did it help?
  • Do you feel that you've aged due to chronic stress?

  • In the past month, how often have you:
  • Should be Empty: