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Your Lifestyle Habit Survey Discover where you are now, where you want to be, and how to bridge the gap.

Instructions: For each area, answer the question about your current experience, rate where you are now and where you want to be (1 = very unsatisfied, 10 = thriving), share how ready you are to make changes, and check any improvements you wish you could see in your life.

How do you feel about your nutrition habits?

Improvements I wish I could see:

Better digestion and gut health

Balanced mood and mental clarity

Sustainable, enjoyable eating habits

Improved weight management

Reduced cravings for sugar and processed foods

Easier meal planning and prep

Improved relationship with food (less guilt, more confidence)

Eating to support health conditions or recovery

Nutrition that supports emotional well-being and focus

How do you feel about your physical activity?

Improvements I wish I could see:

Less stiffness, pain, or fatigue

Consistent workouts or movement

Increased daily energy and stamina

Ability to keep up with family or daily demands

Better performance and resilience at work and home

Improved cardiovascular health

More motivation to move and stay active

How do you feel about your sleep quality?

Improvements I wish I could see:

Fall asleep faster and more easily

Wake feeling rested and energized

Consistent sleep schedule

Reduce nighttime anxiety or racing thoughts

Sleep more deeply and soundly

Wake without relying on caffeine

Fewer middle-of-the-night wake-ups

Feel more alert and focused during the day

How do you feel about your ability to manage stress in your life?

Improvements I wish I could see:

Reduce emotional reactivity

Build resilience for life’s challenges

Have daily tools for relaxation

Reduce physical symptoms of stress (tension, headaches, fatigue)

Set healthier work-life boundaries

Handle conflict more effectively

Worry less about the future

Be more present with loved ones

Recover more quickly after stressful events

How do you feel about your relationships and connections at this point in time?

Improvements I wish I could see:

Stronger connection with family, friends, or partner

Feeling more present in relationships

Building trust and better communication

Healthier boundaries with others

Healing from past relationship stress

Feeling less lonely or isolated

Balancing work, family, and social life more effectively

Repairing relationships that feel strained

How do you feel about your ability to limit bad habits, toxins, or substances that might be harming your health?

Improvements I wish I could see:

Reduce alcohol, nicotine, or recreational drug use

Limit exposure to toxins (plastics, chemicals, pollutants)

Replace harmful coping habits (screen time, overeating, emotional eating)

Create healthier routines and boundaries

Spend less time on devices and more time in nature

Improve coping skills for stress and daily challenges

Improve regulation of impulsive behaviors

Reduce reliance on unhealthy 'quick fixes'

Establish healthier lifestyle habits that stick long term

If you were to continue living exactly as you are now, what do you worry will happen in 5-10 years from now?

Please Select:

My health will suffer, and I may face more illness or fatigue.

My eating habits will continue to work against my long-term wellness.

My stress and mood may become harder to manage.

My sleep, movement, and daily routines will decline.

My relationships and sense of purpose may weaken over time.

If you're ready to move beyond quick fixes and create genuine, lasting change, integrative therapy can help you build the healthy habits that stick. Let's create a practical, realistic roadmap to your wellness goals—schedule your FREE complementary consultation to get started.

*Consult not required to submit your survey. But if you're ready to commit to your health and wellness goals, now is your chance!

December 2025

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