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HEALing Activation Assessment

As a starting point, it's best to document quantifiable measures of the "condition" you're in, considering both objective and subjective factors.  This simple assessment provides both information for the coaches you may opt to speak to or work with and a baseline for future  comparison.

Before beginning, download the Symptoms Checklist and use the sheet to acquire a "Symptoms Score."  DOWNLOAD LINK

Click the button below to start.

Start

Question 1 of 8

What was your Symptoms Checklist Score?

Question 2 of 8

Check any of the conditions you've been diagnosed with

(Select all that apply)
A

An Autoimmune Condition

B

Type 2 Diabetes

C

A Thyroid Condition

D

Hypertension

E

Arthritis

F

None of the Above Apply

Question 3 of 8

Share any further detail on health concerns or conditions

Question 4 of 8

How many medications are you currently on for chronic conditions

A

I am on only one medication for a chronic condition

B

I am on more than one and less than four medications for chronic conditions

C

I am on four or more medications for chronic conditions

D

I am not on any medications for chronic conditions

E

This is difficult to answer as I have a unique situation so I'll address "meds" when asked for "Additional Comments"

Question 5 of 8

Which of the following best address your concern with the scale / weight

(Select all that apply)
A

I feel great and weigh within 10 pounds of what I consider my ideal

B

I'd estimate that I'm between 10 and 20 pounds overweight

C

If I'm being honest, I'd like to lose between 20 and 30 pounds to feel good

D

Seeking optimal health and well-being, I'd likely want to lose more than 30 pounds

E

Weight just isn't a factor for me and my body composition seems OK

F

I've struggled with weight for a long time and just stopped worrying about it

G

None of the above options really apply. I'll share more detail in COMMENTS

Question 6 of 8

Although there may be several things, what is the one most pressing thing you'd like to change related to health, energy, fitness, or well-being?

Question 7 of 8

ADDITIONAL COMMENTS: Here's Your Opportunity to Share Any Information Phil or the Coaches Might Find Valuable in Charting Your Best Course Forward.

Question 8 of 8

Please print your full name, email address, and if you have a relationship with or preference for any of the Coaches, share who you'd see as the best fit for you.

Confirm and Submit