Free Wellness Assessment

 

Holistic Assessment - An Opportunity to Select One Item, Put a Plan Together for Change...See How You Can Increase Your Health and Well being By Starting Right Now

The following questions have been developed to assess your overall health from a physical, mental, energetic, and spiritual perspective. They come from 4 dimensions of functioning that will allow you to see yourself from a holistic perspective. Put a check by the sentences that are true. When you are finished, select one and only one item from the assessment and fill out your plan and the support you need for changing the item. Our computerized program will add up your totals and we will automatically send the totals back to you. We will also contact you for follow up on your plan unless you check that you do not want that.

 

  Nourishment
I eat a low-fat, moderate carbohydrate diet.
I eat a low-no red meat diet.
I eat a low-sugar diet.
I eat several servings of vegetables each day, including leafy green vegetables.
I put myself in situations that stimulate my creativity.
My life is filled with people who bring out the best in me.
I accept love easily from others.
One way I demonstrate love for myself is by taking good care of myself.
My soul or spirit feels nourished daily.
I drink enough water daily (body weight divided by 2 for ounces per day.)
I earn a sufficient income so that I do not worry about my finances.
My digestive system functions effectively-no gas, indigestion, or parasites.
I eat when I am hungry.
I drink fluids when I am thirsty.
  Cleansing
My joints move easily without pain or stiffness.
My skin is clear.
I move my bowels daily.
My weight is within the normal range for my height and build.
My tongue is not heavily coated.
I clean my teeth at least once a day.
In my living space, I only have things around me that I use or enjoy.
My closets are orderly.
My living space is clean.
I forgive others and myself easily.
I have compassion and love for my parents (or caretakers) in regards to things they did which brought pain or problems into my life.
If anyone in my life were to die today, I would feel that I had said what I needed to say to that person.
I easily let go of ways of acting, thinking or feeling that are not helpful.
If I become upset, I can usually resolve the issue within a day or two.
  Activity
I stretch for about 10 minutes at least once a day.
I walk or do strenuous exercise for about 45 minutes 4 times a week.
I actively pursue hobbies that I find stimulating and creative and have many activities in my life that are fun and energizing.
I spend time out of doors being active at least 30 minutes most days.
I love the work I do for a living.
My life feels purposeful and has meaning.
Activity in my life is balanced by rest and relaxation.
I use my sexual energy in ways that promote the well being of myself and others.
At least several times a day, I am aware of my body as I do physical movement.
I make changes in my life when necessary.
I can easily promote an idea, a cause, or myself.
I can take charge of a situation.
I can readily follow others when I believe in the activity.
I am able to maintain a sense of myself as well as feel a part of a group in a community setting.
  Rest, Quiet, Meditation, and Reflection
I do diaphragmatic deep breathing several times a day.
sit or pray or move in a meditative way for at least 20 minutes each day.
I receive a relaxing massage occasionally.
I spend about 15 minutes a day doing nothing.
I take time alone when I need it.
I usually sleep easily and deeply for as long as I need to sleep.
I can nap easily if I am tired.
I usually wake up refreshed and energized.
I feel grateful much of the time.
I have a 14-hour period of time each 24 hours in which I do not eat. Example--I don't eat from 6 PM to 8 AM.
I spend time daily thinking about what has occurred during that day and what I have learned from it.
I am clear about my inner principles and values and live by them.
I am willing to explore different ways of thinking and feeling about things.
I am able to shift between different ways of thinking and feeling about things.
  Review the assessment and select one question that you would like to change.  You can use this assessment as a way of focusing your energy and moving step by step to a fuller and more satisfying life.  Be gentle and loving with yourself and move slowly but surely.  The people that are successful in making lasting changes in their life usually decide on a goal, make a plan, underpromise when they set weekly objectives, get support, and move little by little toward their goal.  See the setbacks in your progress as a way to learn how you limit yourself and think of them as things that come up to be healed.  Work with a health coach if that is helpful.  Acknowledge and reward yourself with each awareness and step.  Remember that the turtle won the race.
  Total Nourishment (14):
  Total Cleansing (14):
  Total Activity (14):
  Total Rest (14):
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  The support I need to help me with this change is:
 
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AsOne Coaching Institute will not sell or share any information supplied on this form with any third party under any circumstance. This information is only used by AsOne Coaching Institute to communicate with our clients about our products and services.

Copyright 2000 by Linda Bark RN Ph.D.  You can contact her at 510-864-1975 or by email at lbark7777@aol.com for questions about the assessment, for coaching, or for coach training.  The assessment was based on the concept of the four dimensions of functioning as published in Radical Healing by Rudolph Ballentine MD.  This assessment can be duplicated as long as it is copied in it entirety with this acknowledgement.

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