• Revitalize Wellness Assessment

    Tammy Polson
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  • Medical

  • 0/150
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  • *Lithium: The healthcare provider may wish to adjust frequency of lab work for the client and monitor
    **Thyroid Medications: The healthcare provider may wish to monitor thyroid hormone levels while the Client is on the Program and adjust medication.
    ***Coumadin (Warfarin): The healthcare provider may wish to review food choices, conduct lab work and/or adjust medication.

  • 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

  • MOVEMENT

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  • 0/50
  • STRESS

    Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
  • RELATIONSHIPS

    Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
  • MINDSET

    Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
  • SPIRITUAL

    Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
  • FINANCIAL

    Rate the following on a scale of 1 to 5, (1 being Least True and being Most True)
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