RHVHA Wellness & Lifestyle Questionnaire

Welcome to the RHVHA Wellness & Lifestyle Questionnaire

This questionnaire is designed to help me better understand your current lifestyle, nutrition habits, daily routines, wellness goals, and the areas in which you would like support.

Your responses will help guide our conversation and allow me to provide wellness education and coaching that is relevant to your goals.

Please answer each question as openly and accurately as you feel comfortable. This questionnaire is for holistic wellness education and coaching purposes and is not intended to diagnose, treat, or evaluate any disease or medical condition.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date

Height

Current Weight. Please include lb or kg.

Have you experienced any significant or unintentional weight change during the past 6–12 months?

If yes, please describe the change, including approximately how much weight you gained or lost, over what period of time, and anything you feel may have contributed to it.

1. What is your primary reason for seeking Raw Vegan Blessings wellness education and coaching at this time? Please share what has brought you here, what you are currently experiencing in your overall well-being, and what you hope to change, improve, or better understand.

2. What would you most like to improve in your overall well-being, vitality, lifestyle, or relationship with your body? Please describe the changes you would most love to experience.

3. What are the three most important wellness goals you would like to focus on at this time? Please list them in order of importance, with #1 being your highest priority.

4. If your wellness journey were moving in the direction you truly desire, what would be different in your daily life? Please describe how you would like to feel physically, mentally, emotionally, and in your overall vitality and quality of life.

5. On a scale from 1–10, how ready do you feel to make meaningful and consistent changes to support your wellness goals? Please enter a number from 1–10. 1 = Not ready yet | 10 = Fully ready and committed

6. Please describe what you typically eat and drink in a normal day, from the time you wake up until bedtime. Please include meals, snacks, beverages, approximate meal times, and anything you consume regularly.

7. Which of the following best describes your current way of eating? Please select all that apply.

8. How would you describe your current digestion and bowel elimination? Please select all that apply.

9. How would you describe your energy and vitality during a typical day? Please select all that apply.

10. How would you describe your current sleep and how you feel upon waking? Please select all that apply.

11. How would you describe your current stress level and emotional well-being? Please select all that apply.

12. How would you describe your current daily hydration? Please select all that apply

13. How would you describe your current movement and physical activity? Please select all that apply.

14. Which of the following wellness and restorative practices are currently part of your lifestyle? Please select all that apply.

15. Which of the following best describes your previous experience with raw living foods, plant-based nutrition, and holistic wellness practices? Please select all that apply.

16. Do you have any known food allergies, food intolerances, sensitivities, or other dietary considerations that you would like me to be aware of? If yes, please describe them below.

17. Are you currently under the direct care or supervision of a physician or other licensed healthcare professional for a diagnosed medical condition that requires specific dietary or nutrition-related management?

18. Are you currently taking any prescription medications or receiving ongoing medical treatment?

If yes, please list the medication(s), if known, and/or briefly describe any ongoing medical treatment you are receiving. You may also include the dosage and how often you take any medications, if you are comfortable sharing.

18-A. Do you currently take any vitamins, minerals, herbs, nutritional supplements, digestive enzymes, probiotics, or other wellness products?

If yes, please list the products you currently take, including the name, dosage or amount, how often you take them, how long you have been taking them, and what you take them for, if known.

19. What do you feel has been the biggest challenge or obstacle preventing you from creating the wellness, lifestyle, or nutrition changes you would like to make? Please consider things such as time, consistency, motivation, knowledge, stress, family responsibilities, work schedule, cravings, social environment, previous unsuccessful attempts, or anything else that feels relevant to you.

20. How would you currently describe your skin, hair, and nails? Please select all that apply.

21. What would make this wellness consultation most valuable and meaningful for you? Please share what you would most like to understand, learn, receive support with, or feel clearer about by the end of our time together.

22. How would you describe your current relationship with food and eating? Please share anything you feel is relevant. For example, do you generally eat because of physical hunger, routine, convenience, emotions, stress, boredom, cravings, social situations, or comfort? Are there particular times of day or situations when you notice your eating habits change? There is no right or wrong answer. This question is simply intended to help me better understand your current eating patterns and your experience around food.

23. How would you describe your current overall level of stress? 1 = Very low stress 10 = Extremely high stress

24. What do you currently do to manage stress, relax, or help yourself feel more balanced?

25. What are the main sources of stress in your life right now?

26. How would you describe your relationship with yourself at this stage of your life? Please consider your self-talk, self-respect, confidence, and the way you care for yourself.

27. What qualities, strengths, or aspects of yourself do you genuinely appreciate and value?

28. Have you previously done any mindset, personal-development, or self-awareness work? If yes, what practices or approaches have been most helpful to you?

29. Is there anything about making changes to your current lifestyle that feels difficult, uncomfortable, or uncertain for you? If yes, please explain.

30. How supported do you currently feel by the people in your life as you work toward your wellness and lifestyle goals? 1 = I feel very unsupported 10 = I feel extremely supported

31. How do you learn and absorb new wellness information best? Please select all that apply.

32. How do you feel about tracking your wellness habits or progress as part of your journey?

33. What level of structure feels most supportive to you when making lifestyle changes?

34. What type of accountability or follow-up feels most supportive and motivating to you?

35. Are there any foods, beverages, or eating habits that you currently feel unwilling or not ready to change? If yes, please explain.

36. How supportive is your current home or social environment of the lifestyle changes you would like to make?

37. How would you describe the impact of your work, responsibilities, and daily schedule on your ability to care for your well-being?

38. What values are most important to you as you make choices about your health, lifestyle, and overall well-being? For example: vitality, family, independence, longevity, spirituality, confidence, freedom, connection, purpose, or personal growth.

39. What types of personal-care products do you regularly use as part of your daily routine? For example: skincare, cosmetics, toothpaste, shampoo, conditioner, body wash, deodorant, perfume, or other products.

40. What types of household and laundry products do you regularly use in your home? For example: cleaning products, dish soap, laundry detergent, fabric softener, dryer sheets, air fresheners, or other household products.

41. Is spirituality, faith, or a personal belief system an important part of your wellness journey?

42. Is there anything else you feel would be helpful for me to know about you that has not been covered in this questionnaire?

You are welcome to share as much or as little as you feel comfortable sharing. This may include parts of your personal story, childhood experiences, family or relationship life, work or business life, significant life experiences, emotions, feelings, challenges, transitions, or anything else you feel has shaped you and may help me better understand and support you during our work together.

There is no right or wrong answer, and you are never expected to share anything you do not feel comfortable discussing.

Please share only what feels safe and appropriate for you.

Anything you choose to share with me will be treated with care and respect and kept private within our coaching relationship, subject to any applicable legal or safety-related limitations.

Thank You for Completing Your RHVHA Wellness & Lifestyle Questionnaire

Thank you for taking the time to thoughtfully share your wellness journey, lifestyle, goals, and the areas in which you would like support.

Your responses will help me better understand where you are today and will guide our conversation during your consultation.

During our time together, we will explore your goals, current lifestyle, and the areas you would most like to strengthen or transform through holistic wellness education and coaching.

There is no need to have everything figured out before we meet. Simply come as you are, with an open mind and a willingness to learn, explore, and become more connected with your body and your daily choices.

I look forward to meeting you and supporting you on your journey toward greater vitality, awareness, and well-being.

With love, light & Raw Vegan Blessings,
Mariana Kiriakova 🌿💚
Founder, Raw Vegan Blessings
Creator of the RHVHA Method

Raw Vegan Blessings provides holistic wellness education and coaching. Services are not a substitute for medical diagnosis, treatment, or care from an appropriately licensed healthcare professional.

FINAL ACKNOWLEDGMENT Before submitting this questionnaire, please confirm:

By signing below, I confirm that the information I have provided in this questionnaire is accurate to the best of my knowledge, and that I have read and understood the acknowledgment above.

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RHVHA Wellness & Lifestyle Questionnaire

YOUR WELLNESS JOURNEY & GOALS