Whole Health Integrated Self Evaluation
The purpose of this questionnaire is to bring awareness to imbalances in the body by self-assessing physical and emotional symptoms which may point to those imbalances. Taking into account 23 of the body's systems, a relational assessment is possible, viewing the body as a whole organism, rather than as unassociated parts. By uncovering imbalances, steps may then be taken to bring greater balance, harmony, health to the body.
There are 240 questions. Although each one goes quickly, it will take a bit of time; please plan accordingly. (average length of time is 40 minutes).
INSTRUCTIONS: Give every answer a number between 0 (least intense feeling) and 5 (most intense feeling).
Fill out the survey quickly, using your "gut" feeling for each response.
CONFIDENTIALITY: All information is held in strictest confidence. Please be as honest as you can, for the most accurate assessment.
Medical disclaimer: This form is used for SELF assessment, and is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by licensed (wholistic/integrative/functional) medical physicians.
You may take this assessment as many times as you like-- bookmark this page:
. It is recommended to re-assess every 4-8 weeks.
If you have any questions, please email me:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service