Wellness Assessment Let's start with your name: * First Name Last Name Sense of Purpose * I feel a strong sense of purpose in my life: Never Rarely Sometimes Frequently Most of the time How important is having a high level of satisfaction? * On a scale of 1 - 10 1 = Not Important 5 = About as important as other things I would like to achieve now 10 = Most Important Rate Your Confidence * Confidence level in my ability to reach and sustain a higher level of life satisfaction. On a scale of 1 - 10 1 = Not at all Confident 10 = Most Confident Readiness to Change * Please choose one of the below: I am ready to make changes and improvements in my overall life satisfaction No present interest in making a change Plan to change in the next 6 months Plan to change this month Recently started working on this Already doing this consistently (6+ months) I'm interested in addressing the following with my coach. Please check all that apply: OVERALL * Improve well-being (health and happiness) Improve family well-being Improve energy Increase productivity PHYSICAL * Increase physical activity Manage or prevent injury Lose Weight Manage or maintain current weight Improve eating habits Improve health risks or medical conditions MENTAL AND EMOTIONAL * Reduce need for medication Improve work/life balance Improve Sleep Manage stress better or reduce stress Reduce or quit smoking Improve Finances Improve personal relationships SPIRITUAL * Manage drug or alcohol issues Improve job satisfaction Improve life satisfaction Email * Thank you and well done in taking the first steps towards making a change! I will review your assessment and get back to you with the next steps.