6-Month Vitals Assessment

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- Matt Mckinlay
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208.380.8825

Looking back: Where you started to where you are today.

Rate each of the following areas on a scale of 1-10

(1 = worst self, 10 = best self: balanced, energized, and thriving)

6-Month Vitals Assessment

Energy levels throughout the day? *

How stable and positive do you feel emotionally? *

Sleep Quality? *

How many hours of sleep have you averaged over the last 6 months? *

Physical Vitality (e.g., strength, stamina, and ease of movement)? *

Sex drive, libido & satisfaction? *

How clear, focused and mentally sharp do you feel day to day? *

Weight & Body Composition? *

Gut Health & Digestion? *

How has your overall quality of life improved since starting? (e.g. work, relationships, etc.) (1 = minimal change, 10 = Total game-changer) *

Are you living your very best life? If not, what would need to change in order for you to get here? (Your labs will provide more clarity)

Yes

NoNo

Looking ahead, how committed are you to continuing your treatment? (1 = Not likely, 10 = Absolutely) *

What would make saying ‘yes’ even easier to the program? *

What would make saying ‘yes’ even easier to the program? (energy, sleep, emotional stability, physcial vitality, sex drive, libido, brain fog, weight loss)

If you are human, leave this field blank.

Pocatello

208.380.8825 333 N 18th Ave, STE D1,
Pocatello, ID 83201 GET DIRECTIONS

business hours

Mo, We, Th, Fr

9AM - 5PM

12PM - 6:30PM

208.380.8825

Twin Falls

208.758.8586 1285 Florence Ave, Twin
Falls, ID 83301 GET DIRECTIONS

business hours

Tu, We, Th

9AM - 5PM

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