Cover Page
Home
About
What We Do
Who Am I?
Integrative Health Coaching
Client Feedback
Change and the Brain
Coaching Session Prep Form
Wheel of Health
Overview
Mindfulness
Self Care
Mind-Body Connection
Movement, Exercise, Rest
Nutrition
Personal and Professional Development
Physical Environment
Relationships and Communication
Spirituality
Personal Health Plan
Contact
reDefine Health
Cover Page
Home
About
What We Do
Who Am I?
Integrative Health Coaching
Client Feedback
Change and the Brain
Coaching Session Prep Form
Wheel of Health
Overview
Mindfulness
Self Care
Mind-Body Connection
Movement, Exercise, Rest
Nutrition
Personal and Professional Development
Physical Environment
Relationships and Communication
Spirituality
Personal Health Plan
Contact
Personal Health Plan
Please Fill out the following personal health survey
Name
*
First Name
Last Name
Email Address
*
Mindfulness: Awareness of the present moment; paying attention to what you are doing while you are doing it.
*
Where are you now? On a scale of 1 (low) to 10 (high), how would you rate this area of your life?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Movement, Exercise and Rest: Activities of daily living such as cleaning and gardening; exercise activities such as dancing, yoga, walking, running and cycling; adequate rest and relaxation.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Nutrition: Eating a balanced, healthy diet
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Personal and Professional Development: Growing and developing your abilities, talents and interests, both in your personal life and at work; living with both in balance.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Physical Environment: Spaces where you live and work (including safety, light, noise, toxins and color), as well as landscapes surrounding those spaces.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Relationships and Communication: Spending time with family, friends and/or co-workers who are supportive and with whom you communicate effectively.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Spirituality: Seeing purpose and meaning in something larger than yourself. This might include religious affiliation or other areas such as nature or the arts.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Mind-Body Connection: Paying attention to the connection between the mind and body and the effects they have on each other. Using techniques such as breathing and stress reduction practices to help the body relax and heal.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
Professional Care: Prevention and Intervention; Conventional and Complimentary Approaches: Routine Screenings such as mammograms, prostate screenings, colonoscopies, pap tests and dental exams, along with prescribed use of vitamins and supplements. Following treatments recommended by your conventional medical care providers as well as recommended complementary approaches such as acupuncture, massage, hypnosis and osteopathy.
*
Where are you now?
--
1
2
3
4
5
6
7
8
9
10
*
Where would you like to be?
--
1
2
3
4
5
6
7
8
9
10
What stands out for you as significant about where you currently are in any given area of the Wheel of Health?
Thank you!
