Wellness Assessment 2018-02-15T19:12:12+00:00


Your health journey is like your car’s navigation system. You punch in your destination and you trust that your GPS will get you there. But before you hit the road on your journey, the navigation system needs to know where you are right now – that is, where is your starting point? Taking this wellness assessment is the critical first step in helping you get to where you want to go on your wellness journey.

Once the wellness assessment is completed, we’ll decide together the best route for your journey. Will you take the scenic route or will you chose the fastest route to your destination?

Just like when you are driving, once your route is set, you rely on your navigation system to get you there through all the turns. If you should veer off your course along the way, your navigation system directs you back on course so you WILL reach your destination.

My coaching works the same way.  I will be there to guide you along your wellness journey so you can arrive at your desination.

Let’s get started.

1 Step 1
How are YOU (REALLY)?
Wellness Profile

Do you ever find yourself waking up with a feeling of already being 'behind' schedule?

Do you notice thoughts pop into your head about what you 'should' be doing for your health and wellness, but, quicky dismiss them?

Have you stopped to really think about how you feel? Physically and emotionally?

Are you so busy taking care of everyone else's needs that your own on on the "when I have time list?"​ 

Self-assessment is empowering! It is vitally important to the longevity of caregivers and service providers. Just as your client's/student’s/child’s needs change over time, so too will your needs. The purpose of this informal assessment is to reflect on your current health and feelings of wellness. Too often, in our busy lives we ignore those signs and symptoms which keep us from feeling and performing our best. We begin to think that waking up tired and feeling run down and stressed is normal.

This self assessment is not a test! 

It is meant to help you see any disparity between who you are now and WHO YOU WANT TO BE. It will help you focus on your needs and identify areas where change is called for.


Grab a favourite beverage, take a deep breathe and reflect on these questions thoughtfully and honestly. 😊. The questionnaire should take 10 minutes or less to complete but is a valuable investment in your health.

Introduction and Brief Instructions For Best Results

Here are a couple tips that will help you to get the most from this survey:

  • Be brutally honest with yourself – no trying to ‘look good’ for anyone – the scores are for you. 
  • Fair warning - your anxiety may jump a little when answering the questions. That’s okay, just notice it and stay with your honesty. 
  • Change is most often stimulated when we get more uncomfortable than usual. This anxiety is the good kind that can slam the brakes on our automatic pilot. 
  • There are no right or wrong answers. There is just your answer at this moment in time. From this survey, you will be in a better position to see what needs to stay the same and what needs to change. 
  • Even if an answer is not clear, do the best you can.
  • Your answers are completely confidential, and your information will not be shared.

THANK YOU for doing this for YOU!


Our productivity, mood and relationships are all effected by our physical well-being. We all know that when our bodies are not well, we struggle to function at our best. When our bodies are nourished, energized and strong we not only look good and feel terrific, but, we will will likely be more productive, energized and feel happier.

Physical wellness is about so much more than being thin or losing weight. Thin people can be unwell! Optimal physical wellness involves fueling our bodies with proper nutrition and conditioning them with exercise and activities so they can do what we need them to do for a long time.

On a scale of 1 to 10 where would you rate your overall HEALTH over the last 6 months?0 Is UNHEALTHY - - - 10 is VERY HEALTHY
Over the next 5 years, do you see this score:Choose One
On a scale of 1 to 10 where would you rate your overall DAYTIME ENERGY in the last week?0 is Low energy, inattentive, tired - - - - - 10 is Energized and alert, attentive
Over the next 5 years, do you see this score:Choose One
On a scale of 1 to 10 where would you rate your overall STRESS LEVEL and ANXIETY in the last week?0 is Almost constant anxious, worrying thoughts - - - - - 10 is Mostly calm, mindful, contented thoughts
Over the next 5 years, do you see this score:Choose One
What worries you and/or keeps you up at night? Write 'nothing', if you sleep well all night.
What tools do you use to manage stress and anxiety? (Check all that apply)Check All That Apply
Are you currently experiencing the following symptoms or conditions?
ConstipationChoose One
FatigueChoose One
Mood SwingsChoose One
HeadachesChoose One
High or low blood sugarChoose One
Sleep difficultiesChoose One
High or low blood pressureChoose One
Sleep difficultiesChoose One
Hypo/Hypo-thyroidismChoose One
PainChoose One
Diabetes (Type I or II)Choose One

Everything you eat and drink impacts your health and wellness. Nutrition comes down to putting food in your body that FEEDS the cells and organs so they can function properly. Just as vehicles need high quality gasoline in order to operate properly, humans need to fuel our bodies with proteins, carbohydrates, sugar (not the white stuff), fibre, unsaturated fats, and vitamins and minerals.

Healthy eating is about FUEL, not weight loss or being skinny. We cannot change what we don't acknowledge. Be honest about the food you put into your body and ask yourself if it is honestly fueling you or just filling you.

Have you been on a diet or weight loss system before?
If you said YES above, have you kept the weight off?
What do you normally eat for breakfast? Do you eat breakfast every single day?
What do you normally eat for lunch?
What do you normally eat for dinner? Approximately, what time do you generally eat dinner?
How often do you skip meals (breakfast or lunch or dinner)?
In one week, how often do you:
Eat at least 5 servings of fruits and vegetables(one serving equals one piece of fruit or 1/2 cup)Pick One
Eat at fast food restaurants – KFC, Pizza Hut, McDonalds, Wendy’s, Five Guys, Hardee's, Auntie Annie’s etc.Pick One
Eat foods that are high in saturated fat (fried foods, hot dogs, desserts, gravies, and fatty meats)Pick One
Eat foods that are highly processed (breakfast cereals, cheese, tinned vegetables, bread, bacon, sausage, ham, salami, crackers, "convenience foods", such as microwave meals or ready meals, cakes and biscuits. Don’t beat yourself up!! 😊Pick One
Indulge in treats (Chocolate, soda, chips, alcohol, candy and so on)Pick One
Use tobacco products (cigarettes, smokeless tobacco, cigars, pipes)Pick One
If and when you feel sluggish during the day, how do you increase your energy?Choose All That Apply

Movement is critical to your health and longevity! The quality and quantity of your daily movement — your strength and agility impact the way you feel, look and think. Spending time at the gym is excellent for our body and mind. But, movement does not equal formal exercise. We need to count walking, climbing, stretching, squatting as essential to functioning well. Moving your body and exercising improves thinking, self- esteem and a sense of being capable. Be brutally honest about the amount of activity you really do in a day.

In one week, how often do you engage in 20-30 minutes sweat-producing physical activity?Pick One
In what ways do you incorporate movement into your day? Make a list of movements that you intentionally do to avoid being too sedentary.
Is exercise something you schedule or try to find time to do?Pick One
Does your physical activity include: (Check all that apply)

We are more than just bodies walking around in this world. Our bodies, mind and spirit are three closely interrelated aspects of who we are as a whole person. Ignoring one component will eventually leave us feeling stressed, overwhelmed, frustrated or worse.

We must give our attention to nourishing ALL aspects of who we are. Our thoughts, beliefs, emotions and actions matter to our well being and happiness. Just as our physical body needs nourishment, so does our mind and spirit.

When you have FREE TIME, what do you choose to do: (Check all that apply)
How often do you:
Pray/Meditate/Practice MindfulnessChoose One
Gain strength, clarity and peace from your religious and/or spiritual beliefs.Choose One
Do something simply because you enjoy doing it? (hobby or interest)Choose One
Read, watch or listen to something educational or inspirational and/or self-developing?Choose One
Awake in the morning feeling fully rested after sleep.Choose One
Complain, criticize, vent, gossip, seek sympathyChoose One
Feel optimistic about my life and my future.Choose One
Recognize fear, shame, guilt, and insecurity and find constructive ways to deal with it.Choose One
Feel it is safe to share your emotions (fear, love, joy, anger etc.)Choose One
Carve time out of your schedule for a project you care deeply about?Choose One

Relationships matter. In fact, social connections are the most important factor in our health and well-being. Science is making it clear that people who have deep connections to a few people (family, friends and community) are happier, physically healthier and live longer. Of course, quality matters in relationships. Even if bickering occurs sometimes, we NEED people who we really feel we can count on in times of need and when the going gets tough!

Take a moment to reflect on the relationships in your life.

Describe the degree to which you feel able to:
I feel lonely in my daily life.Choose One
I have at least one close relationship on which I depend for emotional support.Choose One
I am able to leave those I love and serve with a trusted friend or relative for a short time so that I get a break.Choose One
I allow others to help me. I can ask for help.Choose One
I add value to my relationships. I am able to give of my time, energy and positive emotions to those who need me.Choose One
I reflect on how my words, actions, body language impact those I am speaking with? How I make others feel?Choose One
When I listen, I hear the speaker's words AND emotions?Choose One

Life can sometimes feel as if everything that happens is beyond our control. It is true that we cannot control many things, but, we always have a choice in how we respond to life's events.

Agency is critical to every human of every age. The ability to set goals, create action plans, manage our emotions and stay motivated is essential to maintain some sense of control over aspects of our lives. This is especially true for those who care for and/or educate an individual with special needs or extra needs. When we don't have direct control over a situation agency is the ability to influence others who have the resources, knowledge, and means to act on our behalf.

Describe the degree to which you feel able to:
I am able to clearly and effectively express my views about the services and supports I think are needed.Choose One
I am able to spend time to pursue my individual interests.Choose One
I am able to take the initiative in looking for services for myself and my client/student/child.Choose One
I am able to create a plan, act on it consistently (for myself or others).Choose One
I have things in my life that need attention and action (household clutter, destructive relationships, addictions, unmanageable debts, etc.)Choose One
To what degree do you feel that you have purpose and meaning in your life?
On a scale of 1 to 10 where would you rate your overall DAYTIME ENERGY in the last week?0 is I do not feel that I have a purpose. There is no meaning to my life. 10 is I believe that I am here for a reason and my life adds value to myself and others.
To what degree do you feel you are making progress towards accomplishing your goals?0 is I am not making progress. 10 is I make consistent progress to what I set out to achieve.

Now that you have taken some time to answer the questions, I would suggest you read through your answers tomorrow or the next day. Do so when you are most alert, rested and in a positive frame of mind so that you can see both the areas you should feel good about as well as those areas that need your attention.

Examine your responses and write down your answers to the following questions:

Choose One
Stress management
Choose One
Exercise and movement
Choose One
Attention to symptoms and conditions
Choose One
What do I feel I am doing well in terms of my physical health?
What do I need to change in order to be as physically healthy as possible?