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Personal Wellness Questionnaire

This questionnaire is to assess your present personal wellness status. If you complete it with a 70% or lower, you should consider contacting a professional holistic health & wellness coach.

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Question 1 of 10

How would you rate your weight gain? 

A

I have experienced unwanted weight gain.

B

My weight has remained stable.

C

I have lost weight recently.

D

I am unsure, or it does not apply to me.

Question 2 of 10

How would you rate your energy levels? 

A

I frequently experience low energy and fatigue.

B

My energy levels are generally average.

C

I have high energy levels most of the time.

D

I am unsure, or it does not apply to me.

Question 3 of 10

How would you describe your mental clarity? 

A

I often experience brain fog and difficulty concentrating.

B

My mental clarity is usually average.

C

I have sharp mental focus and clarity.

D

I am unsure, or it does not apply to me.

Question 4 of 10

How would you rate your spiritual fulfillment? 

A

I feel disconnected and lack a sense of spiritual enlightenment.

B

My spiritual fulfillment is moderate.

C

I feel deeply connected and spiritually fulfilled.

D

I am unsure, or it does not apply to me.

Question 5 of 10

How would you describe your emotional stability?

A

I frequently experience emotional instability, mood swings, or heightened anxiety.

B

My emotional state is generally stable.

C

I feel emotionally balanced and resilient.

D

I am unsure, or it does not apply to me.

Question 6 of 10

How would you rate your overall well-being?

A

I feel generally unwell and dissatisfied with my overall health.

B

I feel healthy and content with my overall well-being.

C

My well-being is average, and there is room for improvement.

D

I am unsure, or it does not apply to me.

Question 7 of 10

Have you noticed any changes or patterns in your diet, exercise, or lifestyle recently that might affect your well-being? Please provide details if applicable. 

Question 8 of 10

Are you undergoing any medical treatments or taking medications that could impact your well-being? Please provide details if applicable. 

Question 9 of 10

Do you use stress management techniques, spiritual practices, or exercises to enhance your well-being? Please provide details if applicable. 

Question 10 of 10

Are there any other factors or symptoms you would like to mention that may be relevant to your well-being? 

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