Wellness-Assessment

Are you ready to improve your wellness?

Are you over 60 years of age? Are you noticing changes to your mobility, memory, body, energy, and/ or your desire to be involved in activities? Are you a grandparent wanting to be more active with your family?

This brief assessment will analyze whether or not you need support to improve your overall wellness.

"*" indicates required fields

Are you a grandparent?*

Yes

How would you describe your overall emotional state?*

Calm. Peaceful.

Uneasy.

Stressed. Anxious.

How would you describe your mobility?*

All Good.

Noticing changes

Struggling

How are your daily function for work tasks, projects, or managing day to day?*

No Changes, all is fine.

I can do everything, but it takes me longer.

I have started to realize that I require help and assistance.

What describes you best regarding sleep and energy?*

I sleep well. I am focused and motivated, and I have lots of energy.

I have more projects than time. Some bad nights of sleep make it harder to get everything done.

I am not sleeping well, and am too tired to complete everything I need to do.

What describes you best regarding how you feel physically?*

I feel well, and can participate in all the activities that I want to.

Sometimes the way I feel interferes with the activities that I want to participate in, so I have to manage my health.

My health is an issue, and has often been interfering with things that I want to do.

What best describes your life events?*

I have no current concerns. My past is in the past and is not affecting me.

Life is mostly calm. I am aware of past events that were challenging, but they rarely bother me.

There are current situations that are difficult. and/ or Recently, past events or situations have been bothering me.

How is your sense of purpose?*

I have always lived my purpose, and still do!

I have done some things in life that I am proud of, but currently am not doing anything special.

I never really found my purpose in life.

Name

First

We are using cookies to give you the best experience on our website.

You can find out more about which cookies we are using or switch them off in settings.