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Health Coaching Assessment

A pulse check on where you are and what you would like to achieve within our coaching sessions.

Click the button below to start your assessment.

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Physical

This section will review your physical health.

Question 2 of 23

On a scale of 1-10, with 10 being optimal, peak health, how would you rate your physical health?

A

1-4

B

5-7

C

8-10

Question 3 of 23

Where do you feel chronically tense or painful in your body?

Question 4 of 23

Where do you feel full of energy or life in your body?

Question 5 of 23

How would you describe your relationship with your body? Has that changed over your lifetime?

Question 6 of 23

What physical activities do you engage in regularly?

(Select all that apply)
A

Exercise e.g., walking, hiking, working out at home or gym. swimming, etc.

B

Getting a massage or other treatment such as acupuncture.

C

Taking a group class such as yoga, aerobics, or strength training.

D

Physical activity in day-to-day work.

E

Work within the home, such as house cleaning or gardening.

Question 7 of 23

What are some activities you would like to learn more about and/or engage in more often?

Question 8 of 23

Do you have habits that you feel negatively impact your physical health?

(Select all that apply)
A

Smoking or tobacco use

B

Excessive alcohol consumption

C

Excessive consumption of sugar, processed foods, and/or fast food

Emotional

This section will review your emotional health.

Question 10 of 23

On a scale of 1-10, with 10 being your best emotional state, how would you rate your emotional health overall? 

A

1-4

B

5-7

C

8-10

Question 11 of 23

Over the course of a month, what emotional states do you find your spend the most time in?

(Select all that apply)
A

Joy and contentment

B

Worry and fear

C

Anger and frustration

D

Sadness

Question 12 of 23

Do you find your relationships to be emotionally fulfilling?

A

Very much

B

Somewhat

C

Not at all

Question 13 of 23

Do you find your work to be emotionally fulfilling?

A

Very much

B

Somewhat

C

Not at all

D

Not applicable - I do not work

Question 14 of 23

Do you have any emotional goals you would like to achieve?

Mental

This section will review your mental health.

Question 16 of 23

One a scale of 1-10, with 10 being the most positive, how would you rate your mental outlook on your life?

A

1-4

B

5-7

C

8-10

Question 17 of 23

How empowered do you feel to make positive changes and improvements in your life?

A

Very much

B

Somewhat

C

Not at all

Question 18 of 23

Can you clearly visualize the changes or improvements you want to make in your life?

A

Very much

B

Somewhat

C

Not at all

Spiritual

This section will review your spiritual health.

Question 20 of 23

On a scale of 1-10, with 10  being the most satisfied, how satisfied are you with your spiritual life?

A

1-4

B

5-7

C

8-10

Question 21 of 23

How would you describe your spirituality? Do you practice a particular faith or religion?

Question 22 of 23

What are some ways you practice your spirituality? 

Question 23 of 23

Do you have any goals in improving your spirituality or spiritual practice?

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