Strategic Wellness Evaluation

Strategic Wellness Evaluation

Thank you for taking time to complete this free wellness evaluation! I am excited to see that you are willing to improve your overall confidence while saving a few dollars in your pocket all for the price of 5-10 minutes!
Name*

First NameLast Name
Email*
example@example.com
Age

Assessment Questions
1. What are you goals?*
2. What have you tried before?*
3. How active are you during the week?
4, How many meals per day do you consume?
5. When was the last time you felt your best? How does that compare to how feel now?*
6. If you had a plan you saw that it worked for others, would you do your best to follow it?*
7. Do have a vision on what you want to look like?*

Lifestyle Assessment
1. How much money do you spend on food and beverage per day and week? ( groceries, restaurants, clubs, fast food, snacks and alcohol)*
2. What do you like to do on the weekend, ( hobbies , activities, movies , sport events) , what's a rough estimate on how much you spend? *
3. How much do you spend on shopping clothes , shoes and accessories per week/month?*
Add total from response 1-3*

Self Reflection Assessment

1. Rate your current confidence: level 1 is low - 10 is high *

	1	2	3	4	5	6	7	8	9	10

1 is Worst, 10 is Best

2. Would you perform better or make money at work /your business with more confidence ?*

YesNoMaybe
4. Where would you travel or shop if you reach your goal?*
5. Would you go out , date or try new things if you had a little more confidence?*

YesNoMaybe
6. Would reaching your goal give you more confidence?*
Should be Empty: