MBM Wellness Quiz
There are 6 Dimensions of Wellness; Physical, Emotional, Social, Intellectual, Occupational, and Spiritual. Showing special attention to each component will lead to peak health, happiness, balance, and fulfillment. I promise. The first step to seeing quite where you may be lacking, or what aspects you can improve on is to complete this MindBodyMeisha Wellness Assessment! This allows both you and I to see exactly where you are and where you could use a bit of help. After completing the MBM Wellness Assessment, you'll receive your score and a few actionable tips. It’s important to be as brutally honest with yourself when answering; this is a judgment-free zone! Let’s see where I can help you, be the best version of you. If you have any questions or concerns, please email me at Care@MindBodyMeisha.com.
Your First Name
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Email
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example@example.com - so I know where to send your results!
I'd love to follow you on social media! What's your IG or Twitter username?
Phone Number
Optional: You'll be added to my VIP text list where you can ask me health & nutrition questions :)
Gender
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Please Select
Male
Female
N/A
On average, how many hours of sleep are you getting at night?
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Less than 5 hours
5 - 6 hours
7 - 8 hours
9+ hours
Are you getting paid for doing something you love?
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Yes, I love my job
No, I hate my job
Working On It
How often are you doing things to take care of yourself/practice self-care? (daily routines, journaling, going out for fresh air, facials, walks, working out, eating clean, etc)
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Everyday
Few Times A Week
Once Monthly
Never
How often do you smoke cigarettes?
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Everyday
Few times a week
I don’t smoke at all
I don’t smoke cigarettes but I smoke cannabis
How many bottles of water (16oz) do you generally drink daily?
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0 bottles, I’m more of a juice kinda person
1-2 bottles
3-4 bottles
5+ bottles
How often do you drink juice or soda (excluding cold-pressed)?
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Daily; I love it
Sometimes (2+ a week)
Once in a while ( once a month)
Never
How many meals do you eat per day?
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1, a lot of times I forget to eat or I’m too busy
2, I squeeze in what I can
3, I like to have breakfast, lunch, and dinner daily
3 meals and snacks in between
When do you usually have the largest meal of the day?
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Breakfast/Lunch (Early in the day)
Dinner (towards the end of the day)
All meals are the same portion size
How many servings(1cup or handful) of fruit do you eat every day?(smoothies & cold-pressed juices included)
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0, I don’t like fruit. I think it has too much sugar
1
2
3+
How many servings(1cup or handful) of vegetables do you eat daily?(smoothies & cold-pressed juices included)
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0, vegetables? Yuck
1, I incorporate it with one meal a day
2, I incorporate it with two meals a day
3+, I incorporate it with every meal and even snack on it sometimes too(3)
How often do you get at least 30min of physical exercise?
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0 times, I don’t exercise
1-2x weekly, whenever I can squeeze it in
3-4x per week
5+ times weekly
How often do you have fried food (fries, fried chicken, donuts, etc.)?
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Daily, it tastes so good
A few times a week, yumm
Once a week, I like moderation
Rarely (Once a month)
Never
When cooking, do you prefer butter or oil?
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Butter me up!
Oil me down
How often do you eat until you're 100% full/stuffed?
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Every meal; what’s the point of eating if I’m not stuffed after?!
Sometimes; depends if I really like what’s on my plate
Rarely, I like to eat until I’m 80% full
After you eat your favorite meals, how does your body feel shortly after?
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I want a nap, the itis got to me
I don't really notice a difference
Full of energy and ready to conquer what’s next
Some days I need a nap, some days I have the energy
How often did you take a post-lunch nap in the last month?
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All the time
Sometimes
Almost never
What is your preferred choice of alcohol?
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Beer
Wine
Light liquor (Gin, Vodka, Tequila
Dark liquor? (Cognacs, Whiskey)
None, I don't drink
What do you do in your spare time? Pick which activity is most similar
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Watch TV/Scroll Social Media
Work
Play Sports
Read a book/Play instruments
Anything fun outdoors
What's your overall mood like in the last 6 months?
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Relaxed and peaceful
Sad and depressed
Happy and excited
Up & down
Back
Next
What are your usual means of transportation?
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Walk
Drive/cabs
Bike
Public Transportation
Do you hang out with your friends often?
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Yes. We always get together to hang out or virtually speak
Not really. Most of the encounters are purely social
No. We are just too busy
I like to stay at home, and I don't have many friends
Do you food journal and document what you eat on a regular basis?
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No, who has time for that?
Sometimes, if I remember
Yes, every day
Do you find joy in eating healthy foods?
Joy? No..I do it because I need to be healthy
Yes, eating healthy is fun for me
Sometimes, depends on my mood
Do you have some short term goals?
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Yes
No
Do you have some long term goals?
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Yes
No
What kind of results are you looking for for yourself?
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Quick fast results
Long-term transformation and lifestyle change
I’m not sure, I need help with setting goals
Have you ever struggled with an eating disorder?
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Yes
No
I’m not sure
What is your weight loss/ weight gain goal for the remainder of the year? What feels achievable?
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5-10lbs
10-20lbs
20-30lbs
40+lbs
If someone told you that you’d need to throw away all the foods in your cupboards today and go shopping for different foods that are more appropriate to your goal, would you do it?
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Yes
No, I dont have money to waste
Maybe
What do you think about eating healthy?
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It's boring and unfulfilling. I do it when i have to
I’m neither here nor there
I love it and it brings me joy
Your Score
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