Healthy Human Evaulation
Name
First Name
Last Name
Email
example@example.com
Chiropractic
*
Rows
Very False
Mostly False
Generally True
Very True
I understant health is a process not an event
1
2
3
4
I feel more connected to myself, my life, others.
5
6
7
8
I am less reactive when stressed
9
10
11
12
I feel centered and regulated in thought, mood and body
13
14
15
16
I have more clarity for myself and my life
17
18
19
20
Hydration
*
Rows
Very False
Mostly False
Generally True
Very True
I start each day with 16 oz water and a pinch of salt (gel water)
21
22
23
24
I have fewer or less severe food cravings
25
26
27
28
I drink only 6 ox of water with meals
29
30
31
32
I avoid soft drinks and/or processed fruit juices, coffee, alcohol, and caffeinated teas
33
34
35
36
I drink a minimum of 16 oz of additional gel water (other than am gel water) throughout the day
37
38
39
40
Gylcosylation
*
Rows
Very False
Mostly False
Generally True
Very True
I feel energized, clear, and focused throughout the day.
41
42
43
44
I am able to concentrate easily on projects/tasks and have a great memory.
45
46
47
48
My digestion is good with no gut or digestive discomfort.
49
50
51
52
My immune system is adaptable, I recover faster and easier.
53
54
55
56
I consume glycans (ambrotose) in supplement form every single day .
57
58
59
60
Rest
*
Rows
Very False
Mostly False
Generally True
Very True
I make time for myself daily.
61
62
63
64
I wake feeling rested and refreshed at least 5 nights per week.
65
66
67
68
I turn off all blue lights (TV, tablet, phone, etc) at least one hour before bed.
69
70
71
72
I have a hobby I love to do and do it regularly.
73
74
75
76
I engage in a spiritual practice that I enjoy daily.
77
78
79
80
Movement
*
Rows
Very False
Mostly False
Generally True
Very True
I find time to play every day.
81
82
83
84
I get at least 20 minutes of sunshine and fresh air per day (10 minutes of that outside before 10 am).
85
86
87
88
I feel energized after I move my body and can touch my toes with ease.
89
90
91
92
I take daily attention walks.
93
94
95
96
I change up my movement patterns and routines weekly.
97
98
99
100
Real Food
*
Rows
Very False
Mostly False
Generally True
Very True
101
I eat at least 3 types of vegetables daily.
102
103
104
105
106
I eat a minimum of 2 pieces of fruit daily.
107
108
109
110
111
I eat something living with each meal (not processed or packaged).
112
113
114
115
116
I stay off social media, TV, and my phone when I eat.
117
118
119
120
121
I take the time to slow down and chew my food when I eat my meals.
122
123
124
125
126
Essential Nutrients
*
Rows
Very False
Mostly False
Generally True
Very True
I am consistent with my supplements daily.
127
128
129
130
I understand supplements provide structural support for my cells, and fill gaps my diet is missing.
131
132
133
134
I feel overall better and more clear and energized.
135
136
137
138
I struggle to remember to take my supplements.
139
140
141
142
I've noticed improvement or resolution of an unrelated health challenge than I originally started protocol for.
143
144
145
146
Empowerment
*
Rows
Very False
Mostly False
Generally True
Very True
I have a regular journaling practice/reflection time in the morning and night.
147
148
149
150
I take a moment to regularly connect and ask what I'm looking forward to each morning.
151
152
153
154
Irrespective of the outcome, I will continue to be happy and have a wonderful life.
155
156
157
158
I believe good things can come out of challenging situations and I actively seek to see the good on my journey to health.
159
160
161
162
I have things in my life that challenge and inspire me. They give my life meaning.
163
164
165
166
Relationships
Rows
Very False
Mostly False
Generally True
Very True
Without promoting, I can specify the top 3 actions my partner needs - from me - in our daily lives to feel completely loved.
167
168
169
170
I find meaning in my family life as it stands currently.
171
172
173
174
My significant other and I enjoy date night weekly.
175
176
177
178
I feel heard and understood by my significant other.
179
180
181
182
We create space for growth in our lives every week by enjoying downtime at home.
183
184
185
186
I am committed to taking control of what I can, including but not limited to making lifestyle and dietary changes to improve my health.
187
188
189
190
When stressed I focus on doing the next right thing.
191
192
193
194
My habit and goals are met daily.
195
196
197
198
I feel at peace in my life as it is right now.
199
200
201
202
I create my own reality.
203
204
205
206
Ecosystem
*
Rows
Very False
Mostly False
Generally True
Very True
I can take the term hangry to an all new level.
207
208
209
210
If I miss a meal, I am super irritable and say things I later regret.
211
212
213
214
I feel like a brand new person after I eat.
215
216
217
218
I find it super difficult to lose weight.
219
220
221
222
I constantly crave sugar.
223
224
225
226
I always feel thirsty and use the bathroom a lot.
227
228
229
230
I often feel anxious and sluggish.
231
232
233
234
I find it difficult to concentrate and stay focused.
235
236
237
238
I have trouble sleeping through the night.
239
240
241
242
My cuts and bruises seem to take a long time to heal.
243
244
245
246
I deal with muscle and joint aches.
247
248
249
250
I have a family history of autoimmune issues.
251
252
253
254
I have an autoimmune diagnosis.
255
256
257
258
My nails take forever to grow.
259
260
261
262
My skin gets dry and my hair doesn't grow well.
263
264
265
266
I don't sweat easily.
267
268
269
270
I am tired even after I spent time resting.
271
272
273
274
I have unexplained headaches.
275
276
277
278
My complexion isn't as vibrant as I want it to be.
279
280
281
282
I get cold hands and feet.
283
284
285
286
Submit
Should be Empty: