Revitalize Wellness Assessment

Face the truth. There are no wrong answers, no grade, no rating, not even an interpretation of your responses other than your own thoughtful assessment. Be honest and truthful with yourself. Even when the truthful response is a little embarrassing or painful. This is just a tool to assess where you are currently and how I can help you get where you want to be.

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
NUTRITION
I eat my first meal within the first hour of waking up. *
I eat six meals per day. *
I don’t eat fast food, ever. *
I don’t drink more than 1 caffeinated beverage per day. *
I drink at least 8 glasses of water per day. *

MOVEMENT

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
I stand up at least once every hour throughout the whole day.
I do stretching and/or yoga type exercise at least 3x a week.
I get at least 5000 steps in a week.
I do strength training at least 3x a week.
I go outside at least 1 hour a week.

0/50
STRESS

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
I plan my day out the day before.
I review what I am grateful for every day.
I love what I do and enjoy getting up every day to do my job.
I have a morning and evening routine.
I have undisturbed sleep for at least 8 hours each night.

RELATIONSHIPS

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
I spend at least 10 hours of focused time with my family each week.
There is no one in my life that I haven’t completely forgiven.
I get together with friends at least once a week.
I actively look for ways to support and help advance the success of my friends and family.
It is easy for me to commit to others and honor those commitments.
MINDSET

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
I review my major goals every day.
I believe that I can/will accomplish all of these goals.
I do not entertain any negative thoughts.
I always say no to requests or obligations that don’t fit my core values or objectives.
I read something instructional or inspirational for at least 30 minutes each day.

SPIRITUAL

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
I consider myself a spiritual person.
I have a personal relationship with my spiritual source.
I live completely in accordance to my spiritual beliefs.
I consistently use my spirituality to help myself resolve problems.
I consistently use my spirituality to help others.
FINANCIAL

Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
I have a completely detailed budget and unfailingly stick to it.
I have an updated and complete last will and testament.
I am credit card debt free.
I save at least 10% of my income every month.
I have a detailed retirement plan that will accommodate exactly what I need to live as I desire after retirement and for the rest of my life.
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NUTRITION