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

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