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anALYZE
Comprehensive Health Assessment

Your answers shape your personalized testing protocol. Answer every section honestly — there are no wrong answers. The more specific you are, the more personalized your protocol.

About You

Full Name
Date of Birth
Phone
Email
City / State
Assessment Date
Assigned Practitioner

Section 1 · What Brings You Here

Your Concerns
1. What are the top 1–3 health concerns you'd like help with?
2. How long have you been dealing with these concerns?
Less than 3 months
3–12 months
1–3 years
More than 3 years
3. How much are these concerns affecting your quality of life?
1 = Minimal10 = Severely
4. Have you sought professional help for these concerns before?
Select all that apply
No — first time
Yes — primary care physician
Yes — specialist
Yes — naturopath / functional / integrative
Yes — other
Your Goals
5. What does "feeling better" look like for you?
6. What are your top health goals?
Select all that apply
More consistent energy throughout the day
Better digestion and gut health
Hormone balance
Better sleep quality
Improved mood and mental clarity
Weight management
Reduced pain or inflammation
Improved athletic or physical performance
Longevity and healthy aging
Stress resilience
Other
7. What have you already tried to improve your health?

Section 2 · Your Health History

Past Diagnoses
8. Have you ever been diagnosed with any of the following?
Select all that apply
Thyroid disorder
Hormone imbalance (PCOS, menopause, low T, etc.)
Digestive issues (IBS, reflux, bloating, constipation, diarrhea)
Autoimmune condition
Anxiety or depression
Chronic fatigue or burnout
Diabetes or blood sugar issues
Cardiovascular disease
Allergies or asthma
Osteoporosis or bone density concerns
Cancer (past or current)
None of the above
9. Any other diagnoses not listed above?
10. Have you had any major illnesses, surgeries, or hospitalizations?
No
Yes
11. If yes, please describe:
Injuries & Pain
12. Do you have past or current injuries affecting your movement?
No
Yes
13. If yes, describe location / type / when:
14. Do you experience chronic pain?
No chronic pain
Yes
15. If yes, describe location and duration:
Current Medications & Supplements
16. Are you currently taking prescription medications?
Yes
No
17. Are you currently taking supplements or herbs?
Yes
No
18. Are you currently taking over-the-counter medications regularly?
Yes
No
19. If yes to any above, list all (include dosage if known):
Family History
20. Do immediate family members have a history of any of the following?
Select all that apply
Heart disease or stroke
Type 2 diabetes
Cancer (any type)
Autoimmune disease
Thyroid disorders
Mental health conditions
Obesity or metabolic syndrome
Osteoporosis
Alzheimer's or dementia
None of the above known
21. Any other significant family health history?

Section 3 · Your Body Right Now

Rate each symptom: 0 = Never · 1 = Sometimes · 2 = Often · 3 = Every Day
Energy & Fatigue
22. How is your energy level most days?
High — energized and productive
Moderate — get through the day with effort
Low — tired most of the time
Very low — fatigue significantly limits daily activities
23. Fatigue or low energy
0 = Never3 = Every Day
24. Persistent fatigue not relieved by rest
0 = Never3 = Every Day
25. Fatigue with exertion
0 = Never3 = Every Day
26. Fatigue after eating
0 = Never3 = Every Day
27. Slow recovery from illness or exercise
0 = Never3 = Every Day
Digestive & Gut Health
28. Bloating after meals
0 = Never3 = Every Day
29. Abdominal pain or cramping
0 = Never3 = Every Day
30. Constipation
0 = Never3 = Every Day
31. Diarrhea
0 = Never3 = Every Day
32. Food sensitivities
0 = Never3 = Every Day
33. Sugar or carbohydrate cravings
0 = Never3 = Every Day
34. Skin issues (eczema, psoriasis, rashes)
0 = Never3 = Every Day
35. History of low nutrients (iron, B12, etc.)
0 = Never3 = Every Day
Hormones & Metabolism
36. Irregular menstrual cycles
0 = Never3 = Every Day
37. Painful or heavy periods
0 = Never3 = Every Day
38. PMS or mood changes with cycle
0 = Never3 = Every Day
39. Acne or oily skin
0 = Never3 = Every Day
40. Low libido
0 = Never3 = Every Day
41. Weight gain or difficulty losing weight
0 = Never3 = Every Day
42. Hair thinning or loss
0 = Never3 = Every Day
43. Cold hands and feet
0 = Never3 = Every Day
44. Hot flashes or night sweats
0 = Never3 = Every Day
Pain & Inflammation
45. Joint pain or stiffness
0 = Never3 = Every Day
46. Headaches or migraines
0 = Never3 = Every Day
47. Swelling or water retention
0 = Never3 = Every Day
Cardiovascular & Metabolic
48. Chest tightness or palpitations
0 = Never3 = Every Day
49. Shortness of breath with light activity
0 = Never3 = Every Day
50. High blood pressure (known or suspected)
0 = Never3 = Every Day
51. Blood sugar swings (shakiness, crashes)
0 = Never3 = Every Day
52. Weight gain around the midsection
0 = Never3 = Every Day
Liver & Detoxification
53. Dark circles under eyes
0 = Never3 = Every Day
54. Sensitivity to alcohol or medications
0 = Never3 = Every Day
55. Nausea
0 = Never3 = Every Day
Chemical Sensitivity & Toxicity
56. Sensitivity to smells or chemicals
0 = Never3 = Every Day
57. Feeling worse with supplements
0 = Never3 = Every Day
58. Reacting to everything / feeling generally unwell
0 = Never3 = Every Day

Section 4 · Your Mind & Mood

Current State
59. How would you rate your current stress level?
Low — calm, manage stress well
Moderate — some stress but manageable
High — stress is affecting health or relationships
Very high — overwhelmed most of the time
60. How often do your symptoms interfere with daily life?
Rarely
Sometimes
Often
Almost always
Emotional & Cognitive Symptoms
61. Over the past month, have you experienced any of the following?
Select all that apply
Anxiety or excessive worry
Low mood or depression
Feeling overwhelmed or burned out
Irritability or mood swings
Brain fog or poor concentration
Low motivation or apathy
Social withdrawal
None of the above
Cognitive & Brain Health Symptoms
62. Brain fog or mental cloudiness
0 = Never3 = Every Day
63. Difficulty concentrating for extended periods
0 = Never3 = Every Day
64. Memory lapses or forgetfulness
0 = Never3 = Every Day
65. Slower mental processing speed
0 = Never3 = Every Day
66. Word-finding difficulty
0 = Never3 = Every Day
Nervous System & Stress Regulation
67. Feeling "wired but tired"
0 = Never3 = Every Day
68. Panic attacks
0 = Never3 = Every Day
69. Dizziness or lightheadedness
0 = Never3 = Every Day
70. Sensitivity to stress
0 = Never3 = Every Day
71. Frequent illness
0 = Never3 = Every Day
Food & Emotional Eating
72. How would you describe your emotional relationship with food?
Neutral — food is fuel
I sometimes eat emotionally (stress, boredom, sadness)
I often eat emotionally
I have a complicated or difficult relationship with food
73. Are you currently seeing a therapist or mental health professional?
Yes
No

Section 5 · Mental Performance Snapshot

Rate each item 0–10. Scores are tracked over time to measure growth.
Psychological Skills & Mental Strengths
74. Mastery · "How confident are you that you can perform well when things get difficult?"
0 = Not at all confident10 = Extremely confident
75. Vicarious Experience · "When you see others succeed, how much does it increase your belief that you can too?"
0 = Not at all10 = A great deal
76. Self-Talk · "How supportive is your self-talk when you are under pressure?"
0 = Very critical10 = Very encouraging
77. Emotional State · "When you feel anxious or fatigued, how well can you still perform?"
0 = I fall apart10 = I perform just as well
78. Imagery & Focus · "How clearly can you picture yourself executing well in challenging moments?"
0 = Not at all10 = Very clearly
Mindfulness, Awareness & Self-Regulation
Guided exercise: Sit still. Breathe slowly through your nose. Count 4 seconds in, 6 seconds out. Just notice your breath for 90 seconds. Then answer the questions below.
79. "How focused were you on your breathing during the exercise?"
0 = Not focused10 = Fully focused
80. "How aware were you of your body (tension, relaxation, sensations)?"
0 = Not aware10 = Very aware
81. "How easy was it to bring your attention back when it drifted?"
0 = Very hard10 = Very easy
82. "How calm does your nervous system feel right now?"
0 = Very activated10 = Very calm
83. "How confident are you in your ability to reset yourself under pressure?"
0 = Not confident10 = Very confident
Stress, Recovery & Resilience
84. Demand · "How high is your current life + training stress load?"
0 = Very low10 = Extremely high
85. Perception · "How overwhelmed do you feel by your current stress?"
0 = Not at all10 = Completely overwhelmed
86. Response · "When you feel stressed, how effective are your coping strategies?"
0 = Not effective10 = Very effective
87. Recovery · "How well do you mentally and emotionally recover between hard days?"
0 = Very poorly10 = Very well
88. Resilience · "When something goes wrong, how quickly do you bounce back?"
0 = Very slowly10 = Very quickly
Motivation, Values & Goal Clarity
89. Autonomy · "How much do your training and goals feel like your choice?"
0 = Not at all10 = Completely
90. Competence · "How capable do you feel at what you are trying to improve?"
0 = Not capable10 = Very capable
91. Relatedness · "How supported and connected do you feel in your training environment?"
0 = Not at all10 = Very supported
92. Intrinsic Motivation · "How meaningful is this training to you personally?"
0 = Not meaningful10 = Extremely meaningful
93. Goal Clarity · "How clear are you about what you are working toward right now?"
0 = Not clear10 = Very clear
Lifestyle, Habits & Performance Readiness
94. "How consistent are your daily routines that support performance (sleep, focus, nutrition, recovery)?"
0 = Not consistent10 = Very consistent
95. "How helpful is your self-talk during training?"
0 = Harmful10 = Very helpful
96. "How much do your current life demands interfere with training?"
0 = Not at all10 = A great deal
97. "How mentally ready do you feel to train hard today?"
0 = Not ready10 = Fully ready
98. "How confident are you that you can sustain this training for the next month?"
0 = Not confident10 = Very confident

Section 6 · How You Move

99. How often do you exercise intentionally?
5+ days per week
3–4 days per week
1–2 days per week
Rarely or never
100. What types of movement do you do?
Select all that apply
Strength / resistance training
Cardio (running, cycling, swimming)
Yoga, Pilates, or stretching
Sports or recreational activity
Walking
Not currently exercising
Other
101. How many hours per day are you sedentary?
Less than 4 hours
4–6 hours
6–8 hours
More than 8 hours

Section 7 · How You Eat

102. How many meals and snacks do you usually eat per day?
2–3 meals, no snacks
3 meals, no snacks
3 meals + 1–2 snacks
Frequent snacking / grazing
Varies day to day
103. How often do you eat within 1 hour of waking?
Daily
Most days
Occasionally
Rarely
Never
104. When do you typically eat your largest meal?
Breakfast
Lunch
Dinner
Varies
105. How late do you usually eat your last meal or snack?
Before 6:00 pm
6:00–8:00 pm
8:00–10:00 pm
After 10:00 pm
Varies significantly
106. Do you currently track calories or macros?
Yes — actively
Occasionally / loosely
I have in the past
Never
107. Which best describes the types of foods you eat most often?
Mostly whole, minimally processed foods
Mix of whole foods and packaged foods
Mostly packaged / convenience foods
Restaurant or takeout meals most days
Highly variable
108. Which protein sources do you eat regularly?
Select all that apply
Poultry
Red meat
Fish / seafood
Eggs
Dairy
Plant-based (beans, tofu, tempeh)
Protein powders / bars
I don't prioritize protein
109. Are there any foods you avoid or that don't sit well with you?
Select all that apply
Dairy
Gluten
Soy
Sugar / sweets
Sugar alcohols
Spicy foods
High-fat foods
Raw vegetables
None
Other
110. What foods do you enjoy and eat often?
Select all that apply
Eggs
Chicken / turkey
Beef
Fish
Rice / potatoes / pasta
Fruits
Vegetables
Salty snacks
Sweet snacks
Convenience foods
111. What foods do you dislike or avoid — even if they're considered healthy?
Select all that apply
Eggs
Red meat
Fish / seafood
Vegetables
Fruit
Dairy
Whole grains
Protein powders
None
112. What supplements are you currently taking?

Section 8 · How You Sleep & Recover

113. How many hours of sleep do you typically get per night?
Less than 5 hours
5–6 hours
6–7 hours
7–9 hours
More than 9 hours
114. What time do you usually go to bed?
115. What time do you usually wake up?
116. How is your sleep overall?
I sleep well and wake rested (7–9 hrs consistently)
Some trouble — difficulty falling asleep or waking occasionally
I struggle with sleep most nights
I sleep too much but still feel unrefreshed
117. Do you feel rested after a full night's sleep?
Yes, almost always
Sometimes
Rarely
Never
118. Difficulty falling or staying asleep?
Rarely or never
Sometimes
Often
Almost every night
119. Hours per day on screens outside of work?
Less than 1 hour
1–2 hours
2–4 hours
More than 4 hours
120. Do you use screens within 30 minutes of bedtime?
Rarely
Sometimes
Almost every night
Substance Use
121. Do you regularly consume caffeine (coffee, energy drinks, tea)?
Yes
No
122. If yes — last serving time and servings per day:
123. Do you regularly consume alcohol?
Yes
No
124. If yes — drinks per week:
125. Do you regularly use nicotine (cigarettes, vaping, pouches)?
Yes
No
126. Do you regularly use recreational cannabis?
Yes
No
127. Do you regularly use other recreational substances?
Yes
No

Section 9 · Your Time & Commitment

128. How many hours per week can you realistically dedicate to your health?
Less than 2 hours per week
2–5 hours per week
5–10 hours per week
10+ hours per week — health is a top priority
129. Which times of day are generally available to you?
Select all that apply
Early morning (before 8am)
Morning (8am–12pm)
Midday (12pm–2pm)
Afternoon (2pm–5pm)
Evening (5pm–8pm)
Weekends only
130. What is your biggest barrier to improving your health?
Select top 1–2
Lack of time
Lack of motivation or energy
Financial constraints
Unsure where to start
Previous attempts haven't worked
Family or caregiver responsibilities
Work demands
Other
131. How motivated do you feel right now to make meaningful lifestyle changes?
Very motivated — ready to commit fully
Motivated — but I'll need structure and accountability
Somewhat motivated — I have some hesitation
Not very motivated — I'm exploring my options
132. Overall, how would you rate your current health?
Excellent
Good
Fair
Poor
133. Is there anything else we should know about your health or life right now?
✓

Thank You

Your comprehensive health assessment has been submitted. Your practitioner will review your responses and use them to create your personalized testing protocol.

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