Health Check-In Assessment
Name
*
First Name
Last Name
Email
*
example@example.com
Self Rating:
Get a tape measure and measure your waist. Multiply that number by 2. Is that number less than your height in inches?
*
Yes
No
Hang from a bar with arms fully extended. Pull yourself up and get your chin above the bar without kicking or struggling to do so. Were you able to do it?
*
Yes
No
If you had a family event and a 3 on 3 basketball game broke out and you were playing shirts and skins, would you proudly pull your shirt off and go skins?
*
Yes
No
Do you still enjoy an active, healthy sex life?
*
Yes
No
Do you regularly challenge yourself with something outside of your comfort zone? This could be physical or mental (ideally both).
*
Yes
No
Do you get restful, restorative sleep?
*
Yes
No
Do you drink half your bodyweight in ounces everyday? Example, if you weigh 200 lbs, do you drink at least 100 ounces of water each day?
*
Yes
No
Are you stronger today than you were 5 years ago?
*
Yes
No
Do you eat mostly whole foods that have limited added ingredients?
*
Yes
No
If you were a stock, would your broker give a buy recommendation based on your health trend?
*
Yes
No
Do you have a group of like-minded Men you meet with regularly?
*
Yes
No
My health, fitness and mindset is better today than it was a year ago.
*
Yes
No
Do you feel you are leading by example with your approach to aging?
*
Yes
No
Are you looking forward to the next decade?
*
Yes
No
Do you know how many grams of protein you are eating each day?
*
Yes
No
Are you able to sleep without a CPAP or other device?
*
Yes
No
Do you have strategic plan to keep leveling up your mindset, health and fitness as you hit your 60's, 70's and beyond?
*
Yes
No
Do you follow a resistance/strength training program and train 3-4x per week?
*
Yes
No
When it comes to nutrition/diet, do you know how to plan and track macros and calories and how to adjust them to help you lose fat and gain muscle?
*
Yes
No
Do you have a morning routine and an evening routine to plan and reflect on your day?
*
Yes
No
Do you have a mindfulness practice you follow consistently (journaling, breathwork, meditation, reading a book, going for a walk)?
*
Yes
No
Total Score:
Submit
Should be Empty: