Complete this survey by circling yes or no to the questions.

A “Yes” answer means you act on that statement all of the time.

Some of the time or rarely is a “No” answer.

There is no judgement here. This is simply an assessment for you to become more self-aware.

When you are done it will send me the results and I can forward them to you with some ideas of what we can focus on during our health consultations!

This survey is highly inspired by the document A Clean Sweep from the Institute of Integrative Nutrition, Inc. Copyright 2013, 2016.