Health Questionairre

Name(required)

Email(required)

Your Weight

Measurements: Waist and hip(required)

Stress Level Survey 3-5: moderate stress (healthy doses

not overwhelming)

5-7: medium to borderline high levels of stress

8-10: high levels of stress

Sleep Quality? I sleep soundly through the night

I fall asleep as soon as my head hits the pillow

I have a hard time unwinding when it is time to go sleep

I seldom sleep through the night

I wake up tired

Eating Survey I eat healthy 80% of the time

I follow a Paleo diet

I eat a plant-based diet

I eat a diet full of whole and real foods

I am often on the go and I eat what is fast and convenient

I seldom eat "healthy" foods

I eat whatever is handy

What is one wellness goal and why is it a goal?

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