Wellness Assessment

Take this quick assessment to get a snapshot of your current health needs.

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Let's cover the basics first!

A little about you...

Question 2 of 21

1️⃣ Your Email:

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Question 3 of 21

2️⃣ Your First and Last Name:

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Question 4 of 21

3️⃣ The fastest way to contact me is through fb messenger (Homebody Health) or instagram DM's (homebody.health). Please share your Facebook or Instagram handle/account name so I can be on the lookout for your questions.

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Question 5 of 21

4️⃣ If you prefer texting, please enter your mobile number (US residents only)

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Question 6 of 21

5️⃣ Besides email, which method of contact do you prefer:

A

Facebook Messenger or Instagram DM

B

Text

Question 7 of 21

What is your age range?

A

18-25

B

26-34

C

35-44

D

45-54

E

55-64

F

65+

Question 8 of 21

What what does your daily movement look like (not including intentional exercise)?

A

I'm sitting most of the day.

B

I spend about half my time sitting and half my time walking around.

C

I spend most of the day on my feet.

D

I am rarely sitting during the day and have a physically demanding job.

Question 9 of 21

How would you describe the way you fuel your body?

A

I eat mostly whole, nutrient-dense foods and listen to my body's hunger cues.

B

I try to eat balanced meals, but I sometimes skip meals or rely on convenience foods.

C

I often eat on autopilot, without much thought about nutrition or hunger.

D

I go through cycles of restricting certain foods and then overindulging.

E

I eat based more on emotions, cravings, or stress rather than hunger or nutrition.

Question 10 of 21

Do you routinely/intentionally exercise (3-5 times a week)? If so, what are your preferences?

(Select all that apply)

A

I do not have energy to intentionally exercise at this time.

B

Walking or Hiking

C

Low Impact Exercise (Yoga, Pilates)

D

Strength Training (Free Weights or Machines)

E

Cardio focused (Running, Elliptical, HIIT, Cycling, Rowing, Exercise Classes)

F

Participating in sports (Pickleball, Tennis, Golf, Volleyball, Basketball, etc.)

Question 11 of 21

On average, how many hours of sleep do you get each night?

A

8-10 hours

B

6-8 hours

C

Less than 6 hours

Question 12 of 21

How would you rate your stress level?

A

Rarely stressed

B

Occasionally moderately stressed

C

Often very stressed

Question 13 of 21

Do you currently use supplements and if so, do you have a specific brand preference?

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Let's get a bit personal.

😉 Answer as accurately as you can. This is all private and will not be shared anywhere.

Question 15 of 21

QUESTION 1:

(Select all that apply)

A

Diarrhea/IBS-D

B

Constipation /IBS-C

C

Bloating and discomfort

D

Heartburn/GERD/Reflux

E

Candida or yeast overgrowth

F

Chronic stomach or intestinal pain

G

Food sensitivities or intolerances

H

Gassiness and flatulence

I

Antibiotic use

J

White tongue or bad breath

Question 16 of 21

QUESTION 2:

(Select all that apply)

A

Difficulty in losing fat

B

Energy slumps

C

Brain fog or trouble "finding words"

D

Low blood sugar (hypoglycemic) symptoms

E

Elevated blood sugar

F

Needing daily naps (especially after meals)

G

Sugar or carb cravings

H

Afternoon bingeing or mid-day munchies

I

Feeling "Hangry"

J

Hormonal acne or poor complexion

K

Anxiety

L

High triglycerides

M

Late night snacking

N

NEEDING something sweet after you've eaten something salty or savory

O

Inability to go more than two hours between meals

P

Headaches/Migraines

Q

Carb or sugar intolerance

R

Dizziness

S

PCOS

T

Insulin Resistance or Prediabetes

U

Unexplained weight gain

V

High Blood Pressure

Question 17 of 21

QUESTION 3:

(Select all that apply)

A

Rashes or painful skin issues

B

Acne

C

Dry, cracked skin

D

Hair loss

E

Dry lips

F

Red or raw skin around nose and eyes

G

Thinning hair

H

Brittle nails

I

Eczema

J

Rosacea

K

Psoriasis

L

Yeast Infections

You are doing great!

Just a Few More Questions →

Question 19 of 21

QUESTION 4:

(Select all that apply)

A

Low or inconsistent energy

B

Unexplained difficulty with breathing

C

Chronic pain or achiness anywhere in the body

D

Itchy or watery eyes

E

"Puffy" feeling or uncomfortable in your own skin

F

Slightly depressed

G

Irritable

H

Chronic stuffy nose/sniffling/post nasal drip

I

Restlessness

J

Scattered thoughts

K

Drowsy driving

L

Plantar Fasciitis

M

Inability to wear earrings or rings due to inflammation or immune response

N

Autoimmune disease

O

History of tick borne illnesses

P

Pain or fatigue with humidity or temperature changes

Q

Dreading the day ahead or feeling of hopelessness

R

Uninspired or lack of motivation

S

Tingling or numbness in the body

T

Poor nutrition

U

Allergies

Question 20 of 21

QUESTION 5:

(Select all that apply)

A

Chronic Stress

B

Inability to fall asleep or stay asleep

C

Feeling tired, even though you had a full nights sleep

D

Night sweats

E

Horrible PMS

F

Long or irregular menstrual cycles

G

Hormonal imbalance

H

Feeling "wired and tired"

Question 21 of 21

That’s it! Thanks for sharing with me. Keep an eye on your inbox for an email from me—if you don’t see it, be sure to check your spam or promotions folder.

If you have questions or anything else you would like to share with me, please type them below. If not, just type 'no."

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Confirm and Submit

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Email

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Wellness Assessment

Click the button below to start.

Let's cover the basics first!

1️⃣ Your Email:

2️⃣ Your First and Last Name:

3️⃣ The fastest way to contact me is through fb messenger (Homebody Health) or instagram DM's (homebody.health). Please share your Facebook or Instagram handle/account name so I can be on the lookout for your questions.

4️⃣ If you prefer texting, please enter your mobile number (US residents only)

5️⃣ Besides email, which method of contact do you prefer:

What is your age range?

What what does your daily movement look like (not including intentional exercise)?

How would you describe the way you fuel your body?

Do you routinely/intentionally exercise (3-5 times a week)? If so, what are your preferences?

On average, how many hours of sleep do you get each night?

How would you rate your stress level?

Do you currently use supplements and if so, do you have a specific brand preference?

Let's get a bit personal.

QUESTION 1:

QUESTION 2:

QUESTION 3:

You are doing great!

QUESTION 4:

QUESTION 5:

That’s it! Thanks for sharing with me. Keep an eye on your inbox for an email from me—if you don’t see it, be sure to check your spam or promotions folder. If you have questions or anything else you would like to share with me, please type them below. If not, just type 'no."

Confirm and Submit

That’s it! Thanks for sharing with me. Keep an eye on your inbox for an email from me—if you don’t see it, be sure to check your spam or promotions folder.

If you have questions or anything else you would like to share with me, please type them below. If not, just type 'no."