Health Snapshot Exercise

This visual tool assesses your life's balance while kickstarting the process of behavior change with step 1: awareness

First Name

Last Name

Email *

Rate Your Satisfaction in Each Area of Your Life

Scale:

1: Unfulfilled, missing from your life
5: Active component and regular part of your routine

The closer you are to 5, the more fulfilled you feel with that area of your life.

Physical Fitness *

Enter 1 to 5

Movement & Mobility *

Enter 1 to 5

Sleep Quality *

Enter 1 to 5

Stress Managment, Breathwork, Meditation *

Enter 1 to 5

Nutrition *

Enter 1 to 5

Energy Levels *

Enter 1 to 5

Career, Work-Life Balance *

Enter 1 to 5

Fun, Hobbies & Down Time *

Enter 1 to 5

Physical Environment *

Enter 1 to 5

Family *

Enter 1 to 5

Friends *

Enter 1 to 5

Significant Other/Romance *

Enter 1 to 5