Welcome to your Lifestyle Check

Be as honest with yourself as possible - even if it hurts (think about your behaviours over the last month or three). Look at the scale and award your self a score accordingly (remember honesty is very important).

Name & Surname
Business Name
Contact Number
1. Skipping meals/dieting
2. Not exercising or exercising too much
3. Avoiding or neglecting relaxation and other ways to calm your central nervous system
4. Not getting enough sleep
5. Blowing past your own fatigue to finish the day
6. Breathing shallowly when tense, instead of breathing deeply
7. Using sugar, caffeine, nicotine, drugs or herbal stimulants to function at a higher rate when you're already tired
8. Worrying. (Constantly thinking of work related issues even when you are at home relaxing)
9. Mentally replaying stressful inner dialogues
10. Neglecting fun and relaxing activities that allow you to clear your mind
11. You feel you're unable to meet constant demands and you become increasingly overwhelmed and depleted of energy
12. Eating processed, junk or fake foods
13. Putting yourself last. (Never have time to replenish your energy tank)
14. What is you biggest challenge at this stage?
15. Are you working from home?
16. Are you in direct contact with people/clients on a daily basis?
17. When interacting with people are you wearing a.....

If you completed the questionnaire on your mobile phone and you don't see the SUBMIT button, just click the thick BLUE LINE below to submit your answers, and you will see the results immediately.