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Please complete the Lifestyle Assessment Form to begin your journey to wellness!
37Questions
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    46-40:You are doing fantastic in this area! Go forth and inspire others! 30 – 45: You are above average in this area and can improve your score by making some changes. Keep up the good work where you scored a 3 or more, focus on learning more, and get support where you feel you need it most. You got this! 15 – 29: This area is asking for your attention. Continue learning here with us. Make the improvements that feel easiest to change on your own, and reach out to get support where you need it. We are here to help!
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    On average, how many eggs do you eat?

    On average, how many servings of dairy products

    (example milk, cheese, yogurt, ice cream, etc do you eat7 or more3-7 each day?

    On average, how many times do you eat oilfried foods and/or commercially baked goods (cookies, muffins, etc

    On average, how many servings (5 oz of alcohol do you

    46 - 40: You are doing fantastic in this area! Go forth and inspire others!

    30 - 45: You are above average in this area and can improve your score by making some changes. Keep up the good work where you scored a 3 or more and focus on learning more and getting support where you feel you need it most. You

    15 - 29: This area is asking for your attention. Continue learning here with us. Make the improvements that feel easiest to change on your own, and reach out to get support where you need it. We are here to help!

    On average, how many sedentary hours per day do you spend sitting and not moving?

    On average, how many days a week do you engage in some type of cardio exercise (fast walking counts) for 40 minutes or more?

    On average, how many days a week do you engage in some type of resistance or strength training exercises?

    © 2023 Food Revolution Network, Inc. All rights reserved.

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    On average, how many days a week do you engage in some type of stretching or flexibility training (yoga counts)?

    On average how many steps do you get in a day?

    16 20: You are doing fantastic in this area! Go forth and inspire others!

    10 - 15: You are above average in this area and can improve your score by making some changes. Keep up the good work where you scored a 3 or more and focus on learning more and getting support where you feel you need it most. You got

    5 - 9: This area is asking for your attention. Continue learning here with us. Make the improvements that feel easiest to change on your own, and reach out to get support where you need it. We are here to help!

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  • 28

    How often do you feel refreshed after a night's sleep?

    On average, how many hours do you sleep each night?

    On average, how many nights per week do you experience interrupted sleep? (Interrupted sleep is6 7 defined as waking up one or more times

    Do you eat meals or drink liquids (more than 4 - 8 oz fewer than 3 hours before bedtime? How often do you take medication to fall asleep?Always Do you need caffeine (coffee, caffeinated teas and sodas, or dark chocolate) throughout the day forAlways help with energy and focus? Do you require one or more naps for help with Always energy?

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    How often do you have stressful or running thoughts that interfere with your sleep (or with falling asleep)?

    Yes, but I Do you have any form of sleep apnea? If yes, hownever use often do you use a CPAP machine?my CPAP machine

    Yes, IYes, I sometimesalways use my use my

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    28 - 36: You are doing fantastic in this area! Go forth and inspire others!

    18-27: You are above average in this area and can improve your score by making some changes. Keep up the good work where you scored a 3 or more and focus on learning more and getting support where you feel you need it most. You got

    9 - 17: This area is asking for your attention. Continue learning here with us. Make the improvements that feel easiest to change on your own, and reach out for support where you need it. We are here to help!

    How often do you feel you have control over all the demands of life -job, family, or social life? How often do you feel hopeless or depressed? How often are you aware of your emotions and able to express them in a healthy way? How often do you actively feel or practice gratitude?

    How often do you feel your life is driven by yourNever sense of purpose? Are you able to identify and make time for hobbies, family time, fun, and things that bring you joy? How often do you use Mindfulness-Based StressNever Reduction (MBSR) techniques such as meditation, mindful breathing, yoga, tai chi, walking, or other techniques?

    © 2023 Food Revolution Network, Inc. All rights reserved.

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    22 - 28: You are doing fantastic in this area! Go forth and inspire others!

    14 - 21: You are above average in this area and can improve your score by making some changes. Keep up the good work where you scored a 3 or more and focus on learning more and getting support where you feel you need it most. You got

    7 - 13: This area is asking for your attention. Continue learning here with us. Make the improvements that feel easiest to change on your own and reach out to get support where you need it. We are here to help!

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    How long have you smoked, if ever?

    Considering where you spend the majority of your time, is air pollution and/or air quality a great concern to you? Do you buy organic produce as much as possible and wash pesticides off all produce before eatingNever it?

    Do you avoid single-use plastic, avoid BPA, and minimize use of plastics (including storage) aroundNever food?

    Do you use nonstick coated pans including Teflon and other nonstick cookware (containing perfluorooctanoic acid)? Do you drink well-filtered tap water that has the harmful contaminants specific to your location and source removed? (reference EWG Tap Water Database® Do you have and use personal hygiene products or cosmetics that contain high amounts of toxic chemicals? (reference EWG Skin Deep®)

    © 2023 Food Revolution Network, Inc. All rights reserved.

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    Do you have and use household cleaning products that contain high amounts of toxic chemicals? (reference EWG Cleaners Guide

    25 - 32: - You are doing fantastic in this area! Go forth and inspire others!

    16-24: You are above average in this area and can improve your score by making some changes. Keep up the good work where you scored a 3 or more and focus on learning more and getting support where you feel you need it most. You got

    8 - 15: This area is asking for your attention. Continue learning here with us. Make the improvements that feel easiest to change on your own, and reach out to get support where you need it. We are here to help!

    © 2023 Food Revolution Network, Inc. All rights reserved.

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