HSE STARTER GUIDE

HSE STARTER GUIDE

@Atavolino
Welcome to the beginning of a whole new you

Please fill out the following form with up-most accuracy to ensure correct tracking of your progress with The Healthstyle Emporium
NAME
DATE

MonthDayYear
Date
PRODUCT USING
What is your number 1 goal?
Mental, Physical, Emotional etc
What is not serving your journey right now?
Mental, Physical, Emotional etc
What do you know you need to implement to be the best version of yourself?
Mental, Physical, Emotional etc
What support do you want specifically from me?
Mental, Physical, Emotional etc
Next you will go through a range of questions regarding how you currently feel. Please choose the answer that best describes your current state.
1. It is easy for me to get out of bed in the morning
I wake up with energy

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
2. I have sugar cravings constantly
I have sugar cravings constantly

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
My stomach is sore after eating

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I feel I don't have control of my emotions

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I can control my hunger throughout the day

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I wake up feeling well rested

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I drink more than 2L of water a day

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I never suffer from bloating

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I am constantly getting sick

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I often don't feel comfortable in my own body

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I never have energy to do the things I want

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I feel I can't focus properly

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
My muscles are constantly fatigued or sore

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I eat a well balanced diet

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I have emotional awareness and feel when my body needs rest

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I have regular acne breakouts

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I am content with the way my body feels

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
I can control food intake and am conscious of what I put into my body

1

2

3

4

5

1 is Strongly disagree, 5 is Strongly agree
3. I wake up feeling well rested
4. I feel I can not control my emotions
5. I get a sore stomach after eating food
6. I am constantly hungry
7. I drink more than 2L of water in a day
8. After I workout I feel exhausted like I need a nap
9. My muscles take more than a day to recover after exercise (i.e. General 30 min full body workout)
10. I eat a well balanced diet including fruit, vegetables, carbs and proteins
11. I have emotional awareness and can feel when my body needs rest
12. I get skin breakouts on a regular basis
13. I am content with the way my body looks and feels
14. I am able to handle my intake of food daily and am conscious about what I put into my body
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