Wellness Quiz | Safe Frequency Wellness

Step 1 of 6

Let's start with the basics

Full Name *

Email Address *

Age

Gender

Step 2 of 6 · Stress & Mental Load

How is stress affecting your life?

How often do you feel overwhelmed or mentally overloaded?

Rarely — maybe once a month Sometimes — a few times a week Often — most days Almost constantly

How would you describe your current anxiety levels?

Minimal — I feel mostly calm Mild — occasional worry Moderate — noticeable and disruptive High — significantly impacts daily life

How would you rate your work/life balance right now?

Well balanced Slightly off — manageable Poor — work dominates Very poor — I feel burnt out

Anything else about stress or mental load you'd like Yaw to know?

Step 3 of 6 · Energy & Sleep

How is your energy and sleep?

How would you rate your sleep quality on a typical night?

Excellent — I wake up refreshed Good — mostly restful Fair — I wake up tired often Poor — I rarely feel rested

How many hours of sleep do you typically get per night?

Less than 5 hours 5–6 hours 7–8 hours More than 8 hours

How are your energy levels throughout the day?

Consistent and strong Good in the morning, drops by afternoon Fluctuates unpredictably Low most of the day

Any additional context about your sleep or energy patterns?

Step 4 of 6 · Pain & Physical Symptoms

Tell us about pain or physical symptoms

Where do you experience pain or physical discomfort? (Select all that apply)

Head / Neck Shoulders / Upper back Lower back Joints (knees, hips, wrists) Chest / Abdomen No significant pain

How frequently do you experience pain or discomfort?

Rarely or never Occasionally — a few times a month Frequently — multiple times a week Chronic — daily or near-daily

On a scale of 1–10, how severe is your pain or discomfort at its worst?

1

1 — Minimal10 — Severe

Please describe any specific symptoms or physical concerns in more detail:

Step 5 of 6 · Nutrition & Diet

How is your nutrition and hydration?

How would you describe your overall eating habits?

Very healthy — whole foods, mostly home-cooked Fairly healthy — with occasional processed food Mixed — inconsistent or convenience-heavy Poor — mostly fast food or processed meals

How much water do you drink daily?

Less than 4 cups 4–6 cups 7–8 cups More than 8 cups

What supplements are you currently taking? (if any)

Any dietary restrictions, patterns, or concerns you'd like to mention?

Step 6 of 6 · Health Background

A little more about your health history

Current medications (prescription or over-the-counter)

Any diagnosed conditions or ongoing health concerns

Anything else you'd like Yaw to know before your consultation?

Your Wellness
Starts Here

Let's start with the basics

How is stress affecting your life?

How is your energy and sleep?

Tell us about pain or physical symptoms

How is your nutrition and hydration?

A little more about your health history

Your Wellness Snapshot

Book Your 20-Minute Consultation

You're All Set.

Your WellnessStarts Here

Let's start with the basics

How is stress affecting your life?

How is your energy and sleep?

Tell us about pain or physical symptoms

How is your nutrition and hydration?

A little more about your health history

Your Wellness Snapshot

Book Your 20-Minute Consultation

You're All Set.

Your Wellness
Starts Here