Q.1Which of the following best describes you?

  • Male
  • Female
  • Non-Binary

Q.2Which of the following best describes you?

  • Student
  • Entrepreneur
  • Employee
  • Unemployed

Q.3Which area of life is stress affecting you most right now?
(you can select more than one)

  • Relationships
  • Finances
  • Health
  • Career
  • Fun and Recreation
  • Spiritual Growth
  • Personal Growth

Q.4How does stress show up for you?
(you can select more than one)

  • Overthinking, negative thinking or intrusive thoughts
  • Feeling easily agitated, frustrated, and moody
  • Feeling overwhelmed, like you’re losing control or need to take control
  • Struggling to communicate with others
  • Having trouble sleeping
  • Anxiety or nervousness (Eg, unable to focus, forgetful, nail biting, crying, fidgeting…)
  • Physical symptoms (E.g Low energy, gut issues, headaches, tension, chronic pain…)
  • Lack of focus, forgetfulness, being disorganized or poor judgement
  • Avoiding others, procrastinating, avoiding responsibilities, or withdrawing
  • Abusing food, alcohol or other substances
  • Feeling lonely, low self-esteem, worthless, and depressed

Q.5What’s stopping you from being able to overcome your stress?
(you can select more than one)

  • Lacking time
  • Lacking support
  • Feeling overwhelmed
  • Unsure of what to do
  • Feeling demotivated
  • Self-sabotaging
  • Feeling exhausted

Q.6How would you describe your current wellness?

  • I look after myself – 100%
  • Sometimes I do, Sometimes I don’t.
  • I don’t look after myself at all

Q.7When you wake up do you feel...

  • Energized and well rested
  • Tired and restless
  • Like you had lots of vivid dreams
  • Like your sleep was ok - not good or bad

Q.8My sleeping habits looks like this…

  • I wake up throughout the night
  • I insist on good bedtime routine & take sleep hygiene seriously
  • I go to bed and wake up at the same time every day
  • I’m looking at screens until I fall asleep

Q.9What happens when you take time to meditate/breathe/be still?

  • Easily agitated and feel resistance
  • Sometimes it’s hard and sometimes it’s easy
  • Calm and peaceful
  • I don’t

Q.10Observe your breathing, notice where in your body you’re breathing

  • Mid-chest
  • High-chest
  • Belly
  • I don’t know

Q.11I tend to…

  • Listen to my body and adapt my exercise accordingly
  • Exercise because I feel I ‘should’ rather than because I enjoy it
  • Not exercise at all
  • Train until my body hurts. I love that feeling!

Q.12My body…

  • Feels free flowing
  • Feels stiff
  • Experiences pain often
  • Is ready for anything

Q.13 I eat…

  • A mix of healthy and unhealthy foods
  • Like its going out of fashion
  • Without thinking
  • Super healthy

Q.14How much water do you drink per day? (excluding tea, coffee etc)

  • 1.5-2 Litres
  • 1 – 1.5 Litres
  • Less than 1 Litre
  • More than 2 Litres

Q.15How do you usually boost your energy levels when you’re tired?

  • Caffeine or Sugar
  • Fresh air
  • Nap
  • I don’t

Q.16How would you best describe your energy levels?

  • Up and down like a rollercoaster
  • Mostly ok
  • Consistently optimal
  • Tired all time

Q.17I have…

  • More positive thoughts than negative
  • More negative thoughts than positive
  • No idea what I’m thinking most of the time
  • A good mix between positive and warranted negative thoughts

Q.18During challenging times, I…

  • Think resourcefully and adapt accordingly
  • Crumble under pressure
  • Am cautious and adapt slowly
  • Think worst case scenario

Q.19I deal with my emotions by…

  • Learning from them and letting them go
  • Ignoring them
  • Expressing how I feel
  • Distracting myself

Q.20Most of the time I…

  • Feel disconnected to myself and others
  • Am aware of how I’m feeling
  • Feel deeply connected within myself
  • Make others happy before myself

Q.21My current behaviours and vision for my life are…

  • Aligned and on track to achieving what I want
  • Way off track and my goals are moving further away
  • I don’t have a vision for my life
  • I’m not sure

Q.22I show up every day…

  • With clear intentions and confident in who I am
  • To serve everyone else before myself
  • Unclear and unsure of how it will go
  • Knowing I am right where I am supposed to be

Q.23How easy do you find it to maintain a healthy body image?

  • Struggle and don’t like the way I look
  • Somewhat easy but I’d like to improve the way I look
  • My appearance fluctuates and it’s frustrating
  • Easy to maintain and I like the way I look

Q.24The we work with who are experiencing stress in the area of , who are , tend to have one of several wellness challenges.

Which of the following is your biggest challenge right now?

  • Consistency of healthy behaviours like nutrition, exercise and sleep.
  • Struggling to feel emotionally stable, balanced, happy and peaceful.
  • Overwhelmed with thoughts, lacking clarity about myself and the future.
  • Lacking confidence and motivation to act towards what I want.
  • None of the above

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Stress-Free Wellness Scorecard,  

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