Pillars of Health Self Audit
Name
Email
DOB
Mobile Number
General Health
Have you had a DEXA Scan
YES
NO
Are you comfortable with your weight and BMI
YES
NO
Do you know the current status of your hormones?
YES
NO
Exercise and Movement
Do you achieve at least 150 minutes of moderate-high intensity exercise per week?
YES
NO
Does your current exercise program leave you energized, elated and eager to return?
YES
NO
Does your current exercise program leave you energized, elated and eager to return?
YES
NO
Are you happy with your pelvic floor functionality?
YES
NO
Nutrition
Is your consumption of the following UNDER or EQUAL TO the recommended daily amounts? : 6 teaspoons of sugar per day, 10 standard alcoholic drinks per week, 3 cups of coffee per day
YES
NO
Do you drink less than 1.5 litres of water per day?
YES
NO
Are you knowledgeable about current nutritional guidelines for yourself and your family?
YES
NO
Do you eat adequate quantities of fibre, 25 gms or more per day?
YES
NO
Mindset
Do you feel confident inside and out?
YES
NO
Do you regularly achieve goals you set for yourself?
YES
NO
Do you feel empowered to make decisions for yourself and your family?
YES
NO
Do you manage your time well?
YES
NO
Sleep
Sleep - Do you regularly get at least 7 hours of quality sleep per night?
YES
NO
Contact
Would you like to be contacted by one of the wellbeing team?
YES
NO
Submit
Should be Empty: