Kamili Training Solutions Lifestyle & Wellness Assessment Form

Tell us a little about your current lifestyle and wellness activities.

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I often eat foods that are healthy and nutritious.
I rarely feel tired by mid-afternoon, and use for more energy coffee, soda or a candy bar.
I try to include some type of cardio activity into my daily routine. (i.e. walking, running, etc)
I prefer to walk up one or two flights of stairs rather than take the elevator.
I sleep eight hours on most nights.
I get routine health checkups on a regular basis.
I have been successful in maintaining my ideal body weight. I am proud of my body.
An integral part of my leisure time includes physical activity instead of TV viewing or surfing the net.
I do not have any health conditions *
I recover well from illness. *
My self-esteem is not defined by my body image. *
I have a high level of self-confidence. *
I have a way to relax that eliminates stress and keeps me centered. *
I understand that I am more than what I do. *
I have been able to successfully handle stress more than usual lately. *
I feel my body and mind are in perfect harmony. *
I keep my mind alert by enrolling in courses, reading, and learning new things each day. *
I am happy and content with my spouse/partner, or happy being single. *
I feel encouraged when I meet someone that reflects what I want for myself. *
I know what my goals are and I am eagerly and effectively making them a reality. *
I call on a higher power in times of need. *
I feel that I am never too old to change. *
If I discovered that major changes were needed in my life, I would be more than willing to make them. *
I pay close attention to my health and well-being *
I am completely happy with the life I have created for myself. *
I am open to finding new ways to improve myself.
I feel a sense of accomplishment by helping others *
I am satisfied with accomplishing small tasks that contribute to a larger goal. *
I believe that my past experiences can help me reach my future goals. *
I get most of my strength from family, friends, or group support systems. *
I see coaching as a worthwhile investment in providing structure and support in reaching my goals. *
I can pay the coaching fee. *
I am willing to do the work and let the coach do the coaching. *
I feel that I would be interested in working with a coach in a group setting. *
I feel that I am interested in attending personal development workshops or seminars.

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Kamili Training Solutions is dedicated to encouraging individuals to fully maximize their true potential by simplifying lifestyle, career, and wellness goals through realistic personal and organization development solutions, coaching & training programs.
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