• Start of GutStrong

    Personal Health Assessment [PHA]

  • ⚠️ Please Read Before You Begin

    This isn't your standard health assessment...
    Most health assessments collect medical history. This one goes much deeper. You'll explore how you feel, how your health affects your everyday life, and the many factors that influence your wellbeing—including your food, routines, sleep, stress, relationships, home environment, movement, and physical, emotional and mental health.

    Why it matters...
    Your body is always communicating with you. Long before blood tests or diagnoses, it often signals that something isn't right through symptoms, energy, sleep, digestion, mood, pain, skin, weight and countless other subtle clues. Looking at the whole picture helps us understand what's really driving your health and allows us to provide coaching that's personalised to you.

    The questions...
    Every question has been included for a reason—even if it doesn't seem relevant yet. Your microbiome is influenced by far more than food. Your daily habits, environment, relationships and lifestyle all play an important role. The more complete and honest your answers, the more personalised and effective your coaching strategy will be.

    Your opportunity...
    This is your opportunity to pause, reflect and see your health through a different lens—perhaps more deeply than ever before. Some questions may feel confronting, and that's okay. This isn't about judgement. It's about understanding your starting point, identifying what may be holding you back, and taking the first step towards lasting health.

    Please be honest...
    Not "tidy" honest. Real honest. There is no judgement here. The more openly you share your story, the better we can understand your unique circumstances and support you throughout your GutStrong journey.

     

  • Instructions...

    1. We highly recommend completing your PHA on a desktop or laptop, as the written sections can be difficult to complete on a phone.
    2. At the end of the first page (section) click the SAVE button. This will prompt you to create an account (with JotForm) which then emails you a link email link to your saved form. Check junk/spam folder if the link is not in your inbox. Email comes from noreply@jotform.com 

    3. At the end of every page (section) ENSURE you click the SAVE button, then click NEXT if you are still continuing. This way you will never lose any inputted information. Your JotForm email link will take you to the place on the form where you left off. 

  • Personal details

  • Today's Date*
     - -
  • Date of Birth*
     - -

  • HEALTH, MEDICATIONS AND SUPPLEMENTS

    List ALL your ONGOING health issues, conditions, disorders etc. (even little niggles). Do not use terms such as "gut problems" break it down into e.g. reflux, diverticulitis, IBS like symptoms etc.

  • Prescription Medications

    List all prescribed medications (including contraceptives) AND any over-the-counter drugs (e.g. Nurofen, Panadol etc.) you are currently taking (not supplements) If NONE, please type in NONE

  • Supplements

    Please list every vitamin, mineral, probiotic or nutritional supplement you currently take (even if only occasionally). Examples: Magnesium, Vitamin D, Fish Oil, Iron, Zinc, Calcium, B vitamins, Probiotics, Digestive Enzymes etc.

  • Powders, Tonics & Over-the-Counter Health Products

    Please list any health products you regularly or occasionally use that are not included above. This includes protein powders, collagen powders, food powders, fibre products, herbal preparations and over-the-counter products such as antacids.

  • Cosmetic & Beauty Treatments

    Please list any cosmetic or beauty treatments you currently receive or have received in the past 12 months. Examples include Botox®, fillers, laser treatments, IPL, skin needling, chemical peels, cosmetic surgery and similar procedures.

  • Antibiotics

    Please list all courses of antibiotics you can remember taking throughout your life. Approximate dates or ages are okay.

  • Blood tests

    If you have NOT had your blood tests done, please submit the form and when you get your blood tests done (and the results back) please send them by email to hello@nataliewoodman.com. Do NOT delay in submitting your PHA because you're waiting on blood test results.
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  • SLEEP

  • MOOD, STRESS & CONCENTRATION…

    Can be connected with work, home life, social situations, family, friends, relationships, finances, health concerns, world issues.
  • Anxiety... select ALL that apply*
  • Overwhelm... select ALL that apply*
  • Frustration... select ALL that apply*
  • Mind is ALWAYS on... select ALL that apply*
  • Sad and/or lonely... select ALL that apply*
  • Concentration... select ALL that apply*
  • Stress... select ALL that apply*
  • Are you currently under the care of a Psychiatrist, Psychologist or Counsellor/Therapist? Select ALL that apply*

  • DIGESTION…

  • ENERGY…

  • SKIN, HAIR, NAILS, MOUTH…

    We highly recommend taking a photo of any issues, so you have a visual record. This way you can easily compare progress when updating.
  • Face condition... select ALL that apply
  • Body condition... select ALL that apply
  • Hair and Scalp condition... select ALL that apply
  • Fingernails condition ... select ALL that apply*
  • Toenails condition ... select ALL that apply*
  • Tongue condition ... select ALL that apply*
  • Lips, mouth and teeth ... select ALL that apply*
  • Heels of feet... select ALL that apply*

  • RESPIRATORY AND CIRCULATION...

  • ACHES AND PAINS...

  • HORMONES, URINARY...

  • Peri-menopause / Menopause symptoms*

  • Measurements

  • ⚠️ IMPORTANT... Please Read
    Once you've recorded your starting weight and measurements, please don't weigh or measure yourself again until we ask you to (yes, we're serious!).

    Why?

    Because these numbers are simply baseline data—not a measure of your success.

    Real, lasting health isn't built by chasing the number on the scales. That keeps your focus on short-term results. Instead, we want you to focus on the daily habits that create long-term change—better food choices, improved sleep, more energy, calmer digestion, less pain, and all the other signs that your body is healing.

    Trust the process.

    If you know you'll be tempted to jump on the scales, ask a friend or family member to look after them until it's time. You might laugh... but many of our most successful members have done exactly that!

    Your focus is simple... Build a healthier body. The numbers will follow.

  • Visual Health Record

    Photos are one of the most powerful tools you can use to track your progress. While numbers on a scale or measurements can tell part of the story, photos often reveal changes you might not notice day to day. They capture posture, shape, skin health, and overall vitality in ways that written notes cannot. These images will remain private and secure. This is OPTIONAL
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  • Reflection & Commitment

    Before you move on, take a few moments to reflect on what you've just discovered. Awareness is the first step toward change. The questions below are designed to help you turn insight into action
  • Over the next six months, I commit to showing up, staying open, taking action and trusting the process, even when it feels challenging.*
  • Should be Empty: