Assessment Form

WHAT IS THE WHEEL OF LIFE?

The Wheel of Life is a simple yet powerful tool that provides insight into the five dimensions of well-being and their interconnectedness. Complete the free assessment (click below), and the Live Simply Well team will guide you in understanding how smoothly your wheel is rolling and how to enhance your journey.

HOW DO I USE THE WHEEL OF LIFE?

The online assessment tool is easy to use. Simply click the button to begin your wheel, and the system will walk you through rating each area of your life, one step at a time.

HOW LONG DOES IT TAKE TO FILL OUT MY WHEEL?

The assessment typically takes less than a minute to complete.

HOW MUCH DOES IT COST?

Our Wheel of Life is completely free - no hidden fees or strings attached!

WHO IS BEHIND THIS?

This free assessment is provided by the dedicated team at Live Simply Well.

DATE*

MonthDayYear
Date
Hour MinutesAM/PM Option
NAME*

FULL NAMELAST NAME
BEST EMAIL TO REACH YOU*
BEST NUMBER TO REACH YOU*
PHYSICAL HEALTH - HOW WOULD YOU RATE THIS AREA OF YOUR LIFE?*

On a scale from 1-10 (10 being the best)

EMOTIONAL HEALTH - HOW WOULD YOU RATE THIS AREA OF YOUR LIFE?*

On a scale from 1-10 (10 being the best)

FINANCIAL HEALTH - HOW WOULD YOU RATE THIS AREA OF YOUR LIFE?*

On a scale from 1-10 (10 being the best)

SPIRITUAL HEALTH - HOW WOULD YOU RATE THIS AREA OF YOUR LIFE?*

On a scale from 1-10 (10 being the best)

MENTAL HEALTH - HOW WOULD YOU RATE THIS AREA OF YOUR LIFE?*

On a scale from 1-10 (10 being the best)

THANK YOU FOR YOUR SUBMISSION!

One of our coaches will review your submission and get back to you as soon as they can.

In the meantime, do you need an immediate coach? If so, please type in your zip code below and a fellow wellness coach with reach out to you.
ZIP CODE
Should be Empty: