Welcome to your Life Questionnaire Public

Your Name

Your Email

Your Phone Number

Congratulation for investing in yourself and for making you the priority of your life!

At Becoming Excellence, we believe that people who come to us for help, whether, general health, addictions, relationships, weight loss, finance, carrier or lack of meaning and purpose in life. Whichever is the case, we ensure consideration for "all parts," conscious that all other body parts will not work correctly if one body part is not functioning well, because an imbalance of one area will affect the body's overall's health.

Instability in our relationships, the environment we live or work will imbalance our health too. We are all interconnected, affecting "all the parts" affecting one another. We are whole people with passions, dreams, ambitions, and people who love us. From our cells to our organs to people to the community, we are all part of a larger organ called humanity.

Let's start this journey by peeling the layers that may be causing you not to be happy or balance. Let's uncover which areas need our total attention. I want to accomplish by asking you some questions about you, your general health, your habits, your relationships, and your finances.

1. Your Nature

1. What is your data of birth?

Please enter your exact date of birth, day, month, year, and the city your born. The exact time you come to this world. If you don't know the time right now, Please don't forget to send that later. Be mindful that it is critical information for you

2. What is your gender?

3. What is your sexual orientation?

2. Your Soul

let's dig intothe foundation of your character

4. Which of the Following virtues is the GLUE to any relationship?

Integrity

Generosity

Trust

Trustworthiness

5. Adversity is a crossroads that makes a person choose one of two paths: character or compromise. Are the following statements True or False?

1. Character is more than talk. Anyone can say that he has integrity, but action is the real indicator of character.
2. Talent is a gift, but character is a choice. In fact, we create it every time we make choices — to cop out or dig out of a hard situation, to bend the truth or stand under the weight of it, to take the easy money or pay the price.
3. Character brings lasting success with people. Followers do not trust leaders whose character they know to be flawed, and they will not continue following them.
4. Leaders cannot rise above the limitations of their character. Steven Berglas, a psychologist at Harvard Medical School and author of The Success Syndrome, says that people who achieve great heights but lack the bedrock character to sustain them through the stress are headed for disaster. He believes they are destined for one or more of the four A’s: arrogance, painful feelings of aloneness, destructive adventure-seeking, or adultery.

True False

3. Your Mind

6. How often is your mind anchored in the present moment?

All the time Most of the time Some of the time Rarely Never

7. How often are you grateful?

All the time Most of the time Some of the time Rarely Never

8. Feeling everything is an effort?

Not at All A little Moderately Quite a bit Extremely

9. Feeling blue or worthlessness?

Not at All A little Moderately Quite a bit Extremely

10. Feeling suddenly scared for no reason? Nervousness or shakiness inside?

Not at All A little Moderately Quite a bit Extremely

11. Spells of terror or panic? Your worry too much?

Not at All A little Moderately Quite a bit Extremely

12. I like taking part in exciting and noisy parties

Not at All Yes, a little Moderately Quite a bit Very Often

13. To escape routine life, I need something beyond the existing excitement.

Not at All Yes, a little Moderately Quite a bit Very often

14. How often do you feel stressed?

Not at All Yes, a little Some of the time Very often All the time

15. What do you consider the main source of your stress?

Work Family/Friends Medical Medical Relationship Issues or Status Other (please specify)

16. How often do you feel anger?

Not at All Yes, a little Some of the time Very often All the time

17. What do you consider the main source of your anger?

Work Family/Friends/Love Health Finances Inner Thoughts Other (please specify)

18. How often do you feel Happy?

Not at All Yes, a little Some of the time Very often All the time

19. What do you consider the main source of your happiness?

Work Family/Friends/Love Financial Inner Feelings Other (please specify)

4. Your Body

20. What activities do you do for fun or relaxation and how many times/week?

Meditation Deep breathing Art/music Cooking Reading Travel Volunteer work

21. Do you exercise and how many times per week?

0 1 -3 4 times or more

22. Please specify type of exercise

Biking Dance Running Walking Weight training Other

23. Do you have trouble sleeping?

All of the time Most of the time Some of the time Rarely Never Other

24. In the past 2 weeks do you experience any pain or disconfort? if yes please describe what and where :

25. Have you had OR do you presently have any medical condition? If yes, please list them.

26. List the medications you are presently taking.

5. Your Nutrition

27. How many cups of coffee or caffeinated beverages do you normally consume daily?

0 -3 4 -6 7 or more

28. How many 8 oz. glasses of water do you normally drink daily?

0 -2 3 -6 6- 8 9 or more

29. How much-fried foods do you eat?

All of the time Most of the time Some of the time Rarely Never

30. Are you getting 3-5 servings of fruits and vegetables/day?

yes No

31. In general how do you feel about your nutritional habits?

32. How often do you take Omega 3?

Rarely Some of the time Most of the time All of the time

33. How often do you take Vitamin D?

Rarely Some of the time Most of the time All of the time

34. How often do you eat high magnesium content foods like oats, sunflower seeds?

Rarely Some of the time Most of the time All of the time

35. How often do you eat high Iodine content foods like seaweeds or seafoods?

Rarely Some of the time Most of the time All of the time

6. Your Habits

I define a habit as a recurring pattern of behavior, a series of repeated actions.

36. Do you smoke? If yes, how many years?

37. Do you drink? If yes, how many drinks a week?

38. What of the following do you like to do more?

39. Do you procrastinate?

Yes No

7. Your Relationships

40. What's your current relationship status?

Married Engaged In a relationship Single

41. How long have you and your partner been in a relationship?

42. Which of the following health and wellness topics interest you?

nutrition and dietary advice

fitness advice and/or coaching

managing chronic pain and inflammatory disease

managing hypertension, high cholesterol, and/or Type II Diabetes

managing mental health issues

help with meal planning, grocery shopping, or cooking

Other (please specify)

43. How would best describe your relationship?

44. In terms of time, effort, money, attention etc...do you feel that?

45. How do you rate your communication in terms of Frequency, constructiveness, and honesty?

Excellent Good It could be better Frustrating Poor

46. What do you think is trigering the problem?

47. Who else is in your support system?

50. What are your expectations when you finish the program?

Would you be interested in attending a health, wellness, and/or nutrition workshop or event ?

Yes No Not Sure

What do you consider your biggest obstacle in attaining your health and wellness goals?

it is too time consuming

it costs too much money

I lack the motivation

I don't know how to go about achieving my goals

Other (please specify)

Would you like to be contacted regarding Becoming Excellence nutrition and lifestyle consultation and coaching?

Yes

If yes, please provide an email or phone number

41. Which of the following health and wellness topics interest you?

nutrition and dietary advice

fitness advice and/or coaching

managing chronic pain and inflammatory disease

managing hypertension, high cholesterol, and/or Type II Diabetes

managing mental health issues

help with meal planning, grocery shopping, or cooking

Other (please specify)

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Life Questionnaire Public

Congratulation for investing in yourself and for making you the priority of your life!

1. Your Nature

1. What is your data of birth?

2. What is your gender?

3. What is your sexual orientation?

2. Your Soullet's dig intothe foundation of your character

4. Which of the Following virtues is the GLUE to any relationship?

5. Adversity is a crossroads that makes a person choose one of two paths: character or compromise. Are the following statements True or False?

3. Your Mind

6. How often is your mind anchored in the present moment?

7. How often are you grateful?

8. Feeling everything is an effort?

9. Feeling blue or worthlessness?

10. Feeling suddenly scared for no reason? Nervousness or shakiness inside?

11. Spells of terror or panic? Your worry too much?

12. I like taking part in exciting and noisy parties

13. To escape routine life, I need something beyond the existing excitement.

14. How often do you feel stressed?

15. What do you consider the main source of your stress?

16. How often do you feel anger?

17. What do you consider the main source of your anger?

18. How often do you feel Happy?

19. What do you consider the main source of your happiness?

4. Your Body

20. What activities do you do for fun or relaxation and how many times/week?

21. Do you exercise and how many times per week?

22. Please specify type of exercise

23. Do you have trouble sleeping?

24. In the past 2 weeks do you experience any pain or disconfort? if yes please describe what and where :

25. Have you had OR do you presently have any medical condition? If yes, please list them.

26. List the medications you are presently taking.

5. Your Nutrition

27. How many cups of coffee or caffeinated beverages do you normally consume daily?

28. How many 8 oz. glasses of water do you normally drink daily?

29. How much-fried foods do you eat?

30. Are you getting 3-5 servings of fruits and vegetables/day?

31. In general how do you feel about your nutritional habits?

32. How often do you take Omega 3?

33. How often do you take Vitamin D?

34. How often do you eat high magnesium content foods like oats, sunflower seeds?

35. How often do you eat high Iodine content foods like seaweeds or seafoods?

6. Your Habits I define a habit as a recurring pattern of behavior, a series of repeated actions.

36. Do you smoke? If yes, how many years?

37. Do you drink? If yes, how many drinks a week?

38. What of the following do you like to do more?

39. Do you procrastinate?

7. Your Relationships

40. What's your current relationship status?

41. How long have you and your partner been in a relationship?

42. Which of the following health and wellness topics interest you?

43. How would best describe your relationship?

44. In terms of time, effort, money, attention etc...do you feel that?

45. How do you rate your communication in terms of Frequency, constructiveness, and honesty?

46. What do you think is trigering the problem?

47. Who else is in your support system?

50. What are your expectations when you finish the program?

Would you be interested in attending a health, wellness, and/or nutrition workshop or event ?

What do you consider your biggest obstacle in attaining your health and wellness goals?

Would you like to be contacted regarding Becoming Excellence nutrition and lifestyle consultation and coaching?

41. Which of the following health and wellness topics interest you?

49. Please list in order of priority what areas do you think you need more help?

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2. Your Soul

let's dig intothe foundation of your character

6. Your Habits

I define a habit as a recurring pattern of behavior, a series of repeated actions.