Hi! Thanks for reaching out to us.
Which area(s) are you enquiring about?





 
In order to best serve you, we'd like to get to know you a bit better.

We can give you a call to talk through your options, or you can fill out an online life assessment. This way we can better tailor our follow-up and recommendations to your needs.


 
Okay, thanks! What are your full names? *

As it appears on your birth certificate or medical records.
 
...and what would you like to be called? *

Eg. Mr. Smith / Janet / Professor / Doctor / etc.
 
Pleased to meet you, {{answer_qSgzlCgK3qcF}}.
Can you give us a brief description of what we can help you with?

 
What is your preferred contact number, {{answer_qSgzlCgK3qcF}}? *

Example: 07842324535
 
Thank you.
Let's get started with your self-assessment. We recommend that you answer all questions to get the best tailored feedback and recommendations.

These questions are just general self-evaluations of your life. Don't overthink your answers - simply respond with the most instinctual feedback.

TERMS & CONDITIONS: By agreeing to the terms, you acknowledge that all answers given will be treated with strict confidentiality, and will only be disclosed to the health and wellness practitioners assigned to your case. The feedback at the end of this questionnaire does not equate a medical diagnosis or treatment plan. It is merely the initial wellness profile and recommendations. For any final diagnoses and treatment-plans, you will need to be examined by the appropriate health practitioner.

 
You have chosen {{answer_dZ3dhPdbTT5S}} as your focus-areas.

Do you want to do your assessment only on these areas, or would you like an overall assessment: Mind, Body, Relationship and Work?


 
We're sorry to see you leave, {{answer_qSgzlCgK3qcF}}. Would you like us to contact you for a follow-up?

     
 
BODY

 
What is your biological gender? *




 
What is your date of birth? *

 
How satisfied are you with your overall physical health?











 
How well do you rate yourself in terms of movement and fitness?

It's your own self-evaluation of your capacity to move your body the way you want, without pain. This includes fitness, muscles, strength, pain, joints, mobility, flexibility.










 
How do you rate your nutrition & digestion?

This includes how well you eat and hydrate, your gut-health, weight, and any symptoms you might relate to your digestive tract (such as bloating, feeling of fullness, bowel-movements, cramps or even skin-conditions you associate with your gut.)










 
How do you feel about your level of rest, relaxation and stress-management?

This includes adequate sleep, feeling rested after sleep, and having healthy coping mechanisms to support you with life's stressors.










 
Do you have any current medical conditions you want us to be aware of? Please list them below.

     
 
Please list your medical conditions below.

 
If you had to chose only one of the following, which aspect of your body's wellness would you want to work on first?

If all of them seem important, ask yourself which of these could potentially influence the others the most.

 
How motivated are you to work on your {{answer_sbyYq7ysiUu5}} ?

 
If you started working on your {{answer_sbyYq7ysiUu5}} , how confident are you that you can make the necessary changes?

 
If you get help from an expert to improve your {{answer_sbyYq7ysiUu5}}, how much guidance would you need to get where you want to be?

If you know nothing about your condition, and you need an expert to diagnose, treat, and lead the entire process, you could rate yourself as an 8/10.
(Eg: Someone in a car accident = 10/10; Someone who discovered a lump and need a diagnosis = 8/10).
If you know exactly what to do, but you only want a little support, encouragement and input, you might rate yourself as a 2/10.
(Eg: An athlete, who just wants a trainer to monitor their program, count reps, keep them accountable = 1/10.)
 
MIND & EMOTIONS

 
How would you rate your overall emotional and mental health?











 
How well do you think you know yourself?











 
How would you rate your mental clarity and focus?











 
How high would you rate your level of mental stimulation & satisfaction?











 
How satisfied are you about your sense of purpose & meaning in life?











 
How well does your level of knowledge meet the demand on your life?

Eg: if you are in a new job where you feel completely out of your depth, you might score 2/10. If you feel 100% competent in what you do, you'd rate 10/10.










 
Do you have any current mental health conditions you want us to be aware of?

     
 
Please list your mental health conditions below.

 
How much anxiety do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much stress do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much calm do you feel in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How depressive / down do you feel in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much anger do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much joy do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much sadness do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much shame do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
How much fear do you experience in general?

An overall impression of frequency and/or intensity of the emotion in your current life-stage.
 
If you had to chose one area to work on, which aspect of your mental and emotional wellness would you work on first?

If all of them seem important, ask yourself which of these could potentially influence all the others.

 
How motivated are you to work on your {{answer_ZGT3eyxTYeyC}} ?

 
If you started work on your {{answer_ZGT3eyxTYeyC}} now, how confident are you that you could make the necessary changes?

 
If you get help from an expert to improve your {{answer_ZGT3eyxTYeyC}}, how much guidance would you need to get where you want to be?

If you feel completely out-of-your depth, and you need an expert to diagnose, treat, and lead the entire process, you could rate yourself as an 8 or 9. (Eg: You you have a mood disorder, and you need to be diagnosed and treated).
If you know exactly what to do, but you only want some support, encouragement and a little input, you might rate yourself as a 2/10. (Eg: You feel a little anxiety, you know mindfulness works, and you just want an expert to create space for you to do the practice.)
 
WORK

 
How would you rate your overall work situation?











 
How would you rate your level of fulfillment at work?











 
How would you rate your financial returns at work?











 
How well does your skill meet the demand at work?











 
How successful would you rate yourself in your career so far?











 
How would you rate your work-life balance?

 
If you had to chose only one, which aspect of your work & career life do you want to work on first?

If all of them seem important, ask yourself which of these could potentially influence the others if you start working on it first.

 
How motivated are you to {{answer_X8qv1Yq19Ni7}}?

 
If you start working on yourself to {{answer_X8qv1Yq19Ni7}} , how confident are you that you can get where you want to be?

 
If you get help from an expert to help you {{answer_ZGT3eyxTYeyC}}, how much guidance will you need to get where you want to be?

If you don't know what you want to change, and you need someone to tell you what you're good at, you might rate yourself as a 9/10. (Eg: You feel you have a mood disorder, and you just need medication).
If you know what you want to change, but you want some input, support & encouragement to implement the changes, you might rate yourself as a 2/10.
 
RELATIONSHIP

 
How satisfied are you overall with your relationships?











 
How satisfied are you with your family-relationships?











 
Do you have an intimate partner?

     
 
How satisfied are you with your relationship with your partner?











 
How satisfied are you with your intimate life (whether dating or single)?

Whether you are dating, single, or recently single / divorced: just rate the way you feel about this at the moment.










 
How satisfied do you feel about your work relationships?











 
How satisfied do you feel about how you are currently making new connections?











 
How satisfied do you feel about your friendships?











 
If you had to chose only one, which aspect of your relationships would you want to work on first?

If all of them seem important, ask yourself which of these could potentially influence the others if you start working on it first.

 
How motivated are you to work on {{answer_VbdoP6Xd8vnb}}?

 
If you start working on {{answer_VbdoP6Xd8vnb}} , how confident are you that you can get where you want to be?

 
If you get help from an expert to help work on {{answer_VbdoP6Xd8vnb}}, how much guidance will you need to get where you want to be?

If you don't know what you want to change, and you need someone to tell you what you're good at, you might rate yourself as a 8/10. (Eg: You feel you have a mood disorder, and you just need medication).
If you know what you want to change, but you want some input, support & encouragement to implement the changes, you might rate yourself as a 2/10.
 
All done, {{answer_qSgzlCgK3qcF}}!

Please confirm the following details:


Full names: {{answer_LV9hagRfi710}}
Email: {{answer_bwWtDWxIT2qs}}
Contact number: {{answer_tMaWBURdnDqe}}

Focus areas: {{answer_dZ3dhPdbTT5S}}
Thank you, {{answer_qSgzlCgK3qcF}}.
We will be in touch within 24h of the next business day to discuss next steps.
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