QUALITY OF LIFE ASSESSMENT SURVEY

The Quality of Life Assessment Survey is free of charge and may help you better determine if our services would be beneficial to you and your family.

Please respond to the following statements by clicking on the circle adjacent to the response that describes you most accurately. When finished click the Calculate Score button to receive your assessment.

your first name:

I feel the direction my health is going is out of my control.
Strongly disagree Disagree Neutral Agree Strongly Agree

I have a lot of stress in my life.
Strongly disagree Disagree Neutral Agree Strongly Agree

I rarely drink 10-8 oz. glasses of good water every day:
Strongly disagree Disagree Neutral Agree Strongly Agree

I use tobacco:
Strongly disagree Disagree Neutral Agree Strongly Agree

I use recreational drugs:
Strongly disagree Disagree Neutral Agree Strongly Agree

I have debilitating allergies:
Strongly disagree Disagree Neutral Agree Strongly Agree

My diet contains a lot of sugar:
Strongly disagree Disagree Neutral Agree Strongly Agree

I canít find the time or desire to exercise with any regularity:
Strongly disagree Disagree Neutral Agree Strongly Agree

I consume a minimal or moderate amount of alcohol:
Strongly disagree Disagree Neutral Agree Strongly Agree

I have been exposed to serious toxins:
Strongly disagree Disagree Neutral Agree Strongly Agree

I have had a high number of major infections in my life:
Strongly disagree Disagree Neutral Agree Strongly Agree

My body weight is higher than I would like:
Strongly disagree Disagree Neutral Agree Strongly Agree

I canít seem to lose the extra weight I am carrying:
Strongly disagree Disagree Neutral Agree Strongly Agree

I crave sugar or sweets too frequently:
Strongly disagree Disagree Neutral Agree Strongly Agree

I have difficulty falling asleep at night:
Strongly disagree Disagree Neutral Agree Strongly Agree

I wake up tired and groggy in the morning:
Strongly disagree Disagree Neutral Agree Strongly Agree

I need caffeine (coffee, tea, soda) or sugar to get going in the morning:
Strongly disagree Disagree Neutral Agree Strongly Agree

I seem to get sick more frequently than others I know:
Strongly disagree Disagree Neutral Agree Strongly Agree

I worry about my health more than I would like to:
Strongly disagree Disagree Neutral Agree Strongly Agree

If there is a cold or flu going around, I almost always catch it:
Strongly disagree Disagree Neutral Agree Strongly Agree

When I get a cold or the flu, I recover slowly:
Strongly disagree Disagree Neutral Agree Strongly Agree

When I recover from a cold or flu, I frequently have a relapse:
Strongly disagree Disagree Neutral Agree Strongly Agree

When I get emotionally upset, I canít seem to let it go easily:
Strongly disagree Disagree Neutral Agree Strongly Agree

I donít seem to have enough energy to do everything I want to do:
Strongly disagree Disagree Neutral Agree Strongly Agree

I feel like my body is aging faster than normal:
Strongly disagree Disagree Neutral Agree Strongly Agree

My occupation is not fulfilling:
Strongly disagree Disagree Neutral Agree Strongly Agree

I feel the areas of my life (career, recreation, family, friends) are out of balance:
Strongly disagree Disagree Neutral Agree Strongly Agree

I find it difficult to feel peaceful and relaxed:
Strongly disagree Disagree Neutral Agree Strongly Agree

I am not as healthy as I could be:
Strongly disagree Disagree Neutral Agree Strongly Agree

I feel restricted physically from doing the things I want to do:
Strongly disagree Disagree Neutral Agree Strongly Agree


    Your Score                            

If Your
Score Is:
Possible Interpretation
135-150 Indicates strong sense of well-being and energetic balance.
120-134 Indicates a reasonable sense of well-being and energetic balance with room for improvement.
105-119 Indicates there are most likely several areas where imbalances are affecting the quality of life and well-being.
Less than 105 Indicates that there are most likely many areas where energetic imbalances are affecting well-being and productivity.