The information you provide here will be shared with your Health Stewardship Coach. The goal of this assessment is to help you better understand your own thoughts and motivation and give your coach information that will assist them in supporting you as you work to optimize your personal health.

Name *
Mark what best describes your state of being with respect to each of the categories below. Strongly Agree, represents the best-case scenario in that category; Strongly Disagree represents the worst-case scenario.
MENTAL/EMOTIONAL: I have a very positive outlook and a balanced state of mind.
STRESS: I rarely get stressed-out and practice active relaxation regularly.
EXERCISE: I exercise for 45 to 60 minutes per day regularly.
SLEEP: I regularly get 7 ½ to 9 hours of sleep per night and wake up feeling refreshed.
SPIRITUALITY: I feel a sense of fulfillment and peace and a connection to a nurturing, guiding God that I understand.
RELATIONSHIPS: I have meaningful and supportive relationships.
Understanding *
While we never share your information with any 3rd parties, please be advised that the submission and storage of information you provide through this form is not considered secure. Please do not provide any protected health information through this form. If you would prefer to complete a paper version of this form, please contact our office at