Taking a holistic and personalized approach to wellness requires that we get to know each other a bit better. In this questionnaire we will explore aspects of your life that may be relevant to achieving your wellness goals. Being as detailed as you feel comfortable with here will help create a clearer picture of any imbalances and allow us to develop a more robust strategy to optimize vitality in your life.

What would you like to focus on this visit? (Your main health concern(s))
 
What level of stress do you feel at this time, on a scale of 1 (low) - 10 (high)?
 
What are your main areas of stress or disharmony?
 
How does your stress manifest in your life?
 
Do you use any coping mechanisms?
 
On a scale of 1 (low) - 10 (high), how would you describe your energy levels through the day?
 
Any highs or lulls, if so what times of day?
 
How is the duration and quality of your sleep?
 
What does your average days nutrition look like. There is no judgments here, just an honest breakdown of your; breakfast, lunch, dinner and snacks.
 
Do you experience hangrys, low blood sugar or symptoms of hypoglycemia?(short temper, tired, dizzy, poor concentration)
 
Do you experience any symptoms after meals? (Gas, bloating, lethargy, abdominal discomfort)
 
Are there any foods you tend to avoid?
 
What are your wellness goals?
 
On a scale of 1 (low) - 10 (high), how committed are you to achieving your wellness goals?
 

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