Zholistic Life Coaching Assessment

Welcome to Zholistic Life Coaching.This assessment is the first step toward creating a personalized coaching experience designed to help you realign your life — mentally, physically, and spiritually.

Your responses will help us understand your goals, challenges, and lifestyle so that we can develop a coaching plan that truly supports your transformation.

Please answer each question thoughtfully and honestly. All information is confidential and used solely to prepare your Zholistic Life Coaching plan and sessions.

Section 1: Personal & Contact Information

First name

Last name

Birthday

Month

Day

Year

Phone

Preferred Method of Contact

Section 2: Your Story

1. In your own words, what brings you to Zholistic Life Coaching at this time?

2. What do you hope to achieve through this journey?

3. What have you tried before, and what worked or didn’t work?

4. Is there a Scripture, phrase, or personal motto that guides you right now?

Section 3: Health Background

Current Weight (lbs):

Goal Weight (lbs):

Height:

Waist Circumference (inches):

Recent Blood Pressure (if known):

Recent Blood Sugar (if known):

Recent Cholesterol/Lipid Panel (if known):

If you checked any of the above or selected “Other,” please share as much detail as you feel comfortable:

When were you diagnosed?
How does this condition affect your daily life?
Have you received treatment or made lifestyle changes related to this condition?
What would “better” look like for you in this area?

Section 4: Nutrition & Eating Habits

Describe a typical day of eating:

Do you follow a particular eating style (plant-based, standard, keto, etc.)?

How often do you eat out or use convenience/fast foods?

Daily fruit/vegetable servings (approx.):

Most common food cravings:

Food allergies/intolerances:

What do you feel is your biggest challenge with food?

Long answer

What is your relationship with food like? (comfort, fuel, social, discipline, etc.)

Section 5: Movement & Activity

Current exercise routine (type, frequency, duration):

Physical limitations or injuries:

Movement/exercise goals:

How do you feel about your current fitness level?

What would movement with purpose look like for you?

Section 6: Lifestyle & Energy

Average hours of sleep/night:

Do you feel rested when you wake up?

Yes

Current energy levels (1 = very low, 10 = very high):

Stress level:

Low

Medium

High

Main sources of stress:

What changes would help you feel more energized and balanced?

Section 7: Spiritual Life & Renewal

Is faith part of your health journey?

Yes

Unsure

How often do you spend time in prayer, meditation, or Scripture?

Do you have a church or faith community?

Yes

How would you describe your current relationship with God?

Are there areas in your spiritual walk you’d like to strengthen through this journey?

Section 8: Zholistic Wellness Wheel

Rate yourself in each area:

Spiritual

Mental/Emotional

Physical Health

Relationships

Finances

Career/Calling

Environment (Home/Work/Community)

Which area feels strongest right now?

Which feels most in need of renewal?

Section 9: Supplements & Support

Have you ever used natural supplements?

Yes

Which areas interest you most? (check all that apply)

Detox & Cleansing

Daily Vitality & Hormone Balance

Energy & Performance

Heart & Circulation Support

Are you open to incorporating Zholistic Life supplements into your plan?

Yes

Section 10: Coaching Relationship & Communication Preferences

Preferred session frequency:

Weekly

Biweekly

Monthly

Other

Other (please explain):

What would make you feel most supported in our coaching relationship?

How can I best walk alongside you in this journey?

Section 11: Commitment & Vision

On a scale of 1–10, how committed are you to making lifestyle changes?

If you could look ahead 6 months, what would success look like for you?

What would it mean for you personally, spiritually, and physically to achieve this vision?

Section 12: Authorization & Agreement

By submitting this form, I acknowledge and agree to the following:

The information I have provided is true and complete to the best of my knowledge.
I understand that Zholistic Life Coaching provides educational and faith-based wellness guidance intended to support personal growth and holistic health, not to diagnose or treat any medical condition.
I recognize that the success of my coaching journey depends on my personal effort, consistency, and willingness to apply the tools and strategies shared during sessions.
I understand that Zholistic Life and its representatives are not medical doctors, therapists, or licensed mental health professionals, and that all recommendations are made to enhance overall wellness and spiritual alignment.
I consent to the secure collection and storage of my responses for the purpose of creating a customized coaching plan and for future progress tracking.
I release Zholistic Life, its coaches, and affiliates from any liability arising from my voluntary participation in this coaching program.

By signing below, I confirm that I have read, understood, and agree to the terms above.

Signature

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Date

Month

Day

Year

Thank you for completing your Zholistic Life Coaching Assessment.Your openness and commitment allow us to better understand your goals and help guide you toward balance, purpose, and transformation through Christ-centered holistic living.

We look forward to walking beside you on your journey to renewal.

After submitting, please return to the Start Your Journey page to select your coaching plan or visit the Home Page to explore more about Zholistic Life and our holistic wellness services.