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Introduction to the Lifestyle Check-In Quiz

This quiz is designed specifically for business leaders and owners like you. It’s about helping you understand how you’re doing in key areas like energy, eating, stress, and more. As a leader, your health and well-being directly affect your ability to perform at your best and lead effectively. Let’s uncover what might be holding you back.

The process is simple, and there are no right or wrong answers. Just answer honestly, and we’ll help you find ways to improve your performance and thrive in both work and life.

How to Take the Quiz

Step 1 - Read Each Statement:
You’ll see sentences about habits, feelings, or things you do every day.
Step 2 - Think About Yourself:
For each sentence, ask yourself:

"Does this sound like something I deal with?"
Step 3 - Choose Your Answer:
Pick one of the five options that matches how much of a problem it is for you:
- Not a Problem (This isn’t an issue for me.)
- Rarely (It happens every now and then.)
- Sometimes (It’s an issue here and there.)
- Frequently (This happens a lot for me.)
- Critical (This is a big problem I deal with often.)
Be Honest:
It’s okay if something feels like a big challenge. That’s how we’ll know what to focus on to help you!
Complete All the Sections:
The quiz has different areas, like health, stress, and relationships. Try to answer all of them to get the best results.

What Happens After the Quiz?

Once you finish, we’ll look at your answers to see:

What’s going well in your life.
Where you might need some extra help or new ideas.

We’ll share tips, tools, and steps you can take to feel your best and achieve your goals.

Let's get started!

I frequently skip meals or eat at irregular times due to work or other commitments.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I eat while distracted, such as watching TV or working.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I find it difficult to control portion sizes or avoid overeating.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

Processed or fast foods make up a large part of my diet.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I eat fewer than five servings of vegetables and fruits daily.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often snack when I’m thirsty rather than hungry.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I eat in response to stress, boredom, or emotions rather than physical hunger.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I struggle to prepare healthy, balanced meals regularly.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often eat late at night, within two hours of going to sleep.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I avoid certain foods or restrict my diet due to emotional triggers.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Eating Challenges Total

I find it hard to wake up feeling refreshed and energized most mornings.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I have difficulty maintaining a consistent sleep and wake schedule, including weekends.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I rely on caffeine or other stimulants to combat fatigue during the day.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I experience significant energy dips in the afternoon.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I don’t drink enough water (e.g., 2–3 liters per day) to stay hydrated.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

My meals often lack a balance of protein, healthy fats, and complex carbohydrates.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I engage in stimulating screen activities (e.g., phone, computer, TV) an hour before sleep.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel physically drained even when I haven’t done much physical activity.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I notice prolonged periods of exhaustion that affect my focus or ability to perform tasks.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often feel exhausted, even after a full night of sleep.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Energy Challenges Total

I find it hard to get 150 minutes of moderate or 75 minutes of vigorous exercise per week.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I struggle to maintain consistency with my exercise routine.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel bored or uninspired by my current workout routine.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I find it challenging to include strength or resistance training in my fitness routine.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I have difficulty incorporating flexibility or mobility exercises, like stretching or yoga, into my routine.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I spend long periods sitting or inactive without taking regular movement breaks.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel that lack of time, energy, or resources prevents me from exercising regularly.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I lack clear or achievable goals for my fitness routine.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I find it hard to feel comfortable or confident exercising in public spaces.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I experience prolonged soreness or fatigue because I don’t prioritize recovery.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Exercise Challenges Total

I find it hard to make time for self-reflection or practices like journaling to process my thoughts and emotions.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel disconnected from a sense of purpose or meaning in my personal or professional life.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I struggle to acknowledge or appreciate the positive aspects of my life regularly.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I don’t spend enough time outdoors or in nature to recharge and reset.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel isolated from my community or avoid participating in group activities or events.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I find it difficult to contribute to others or causes that matter to me.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel overwhelmed or distracted by spending excessive time on digital devices.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I lack regular mindfulness practices like meditation, yoga, or deep breathing to stay grounded.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

My daily actions and decisions often feel out of alignment with my core values.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel unsafe or disconnected in my own body.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Inner/Outer Connection Total

I find it hard to express my thoughts and feelings clearly to others.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I avoid addressing conflicts due to fear of confrontation or discomfort.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I struggle to balance my professional and personal relationships.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel emotionally unavailable to my loved ones due to work or stress.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

My relationships often feel one-sided, where I give more than I receive.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I lack a group of trusted people I can turn to for support.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often feel isolated or disconnected, even when surrounded by others.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I avoid social situations or relationships because they feel emotionally overwhelming.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I have difficulty setting boundaries with people who demand too much of my time or energy.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I frequently experience tension or misunderstandings in group or work settings.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Relationship Challenges Total

I find it hard to set boundaries between work and personal life.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often experience physical signs of stress, like headaches or muscle tension.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I turn to unhealthy coping mechanisms, like alcohol or overeating, during stressful times.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

Stress frequently disrupts my ability to fall asleep or stay asleep.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel overwhelmed by the demands on my time or have trouble prioritizing tasks.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often procrastinate or avoid tasks when I feel stressed.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I feel emotionally reactive or irritable when I’m stressed.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I find it hard to include relaxation techniques like deep breathing or yoga in my daily routine.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I often feel on edge or hyper-alert, as if something bad might happen.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I struggle to recover emotionally after setbacks or failures.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Stress Challenges Total

I avoid regular health check-ups or screenings (e.g., physical exams, dental visits).(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I have difficulty maintaining a consistent sleep routine, such as going to bed and waking up at regular times.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I struggle to recognize when I’m stressed or how it affects my overall well-being.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I hesitate to seek help or talk to someone when I experience mental health challenges.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I rely on substances like alcohol or smoking as a way to cope with stress or challenges.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

Work-related pressures negatively impact my overall well-being.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I neglect self-care routines like skincare, personal grooming, or leisure activities.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I ignore persistent physical symptoms like chronic pain or fatigue instead of addressing them.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I don’t consider the nutritional value of my meals when making food choices.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

I lack clear or actionable goals to improve my overall health and well-being.(Required)

Not a Problem

Rarely

Sometimes

Frequently

Critical

This field is hidden when viewing the form

Wellness Challenges Total

Name(Required)

First Last

Email(Required)

How old are you?(Required)

18-25

26-35

36-45

46-55

56-65

65+

What is your gender?(Required)

Male

Female

I prefer not to say

Other

What is your current work status?(Required)

Employed

Self-employed/Freelance

Part-time

Homemaker

Student

Not working/between jobs

I prefer not to say

What is your job title?

What is your company name?

Do you provide coaching as a part of your work?(Required)

Yes

No

This field is hidden when viewing the form

Overall Wellness Quotient

Phone

This field is for validation purposes and should be left unchanged.

Δ

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