Welcome to the Holistic Assessment. This form is designed to help you gain a 360-degree view of your well-being across multiple life domains. All information is confidential and used solely for your personal insight.
I consent to the use of my responses for generating a personal holistic report
This section explores your physical health, habits, and lifestyle choices.
On a scale of 1–10, how would you rate your overall physical energy levels?
Do you engage in moderate to vigorous exercise at least 150 minutes per week?
Describe your typical weekly exercise routine:
What is the primary barrier?
Time constraints
Health limitations
Lack of motivation
Financial cost
Other
Average hours of sleep per night:
Do you follow a specific dietary pattern?
Which dietary pattern best describes you?
Mediterranean
Plant-based
Low-carb
Intermittent fasting
Other
Select any physical symptoms you experience regularly:
Headaches
Digestive issues
Back/neck pain
Skin problems
Fatigue
None of the above
How have you felt emotionally over the past week on average?
I feel able to cope with daily stressors.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Have you ever consulted a mental-health professional?
Please share what prompted you to seek support (optional):
How often do you practice mindfulness or meditation?
Daily
Several times a week
Occasionally
Rarely
Never
Average minutes per session:
What prevents you from practicing?
Lack of knowledge
Discomfort with stillness
Time
Skepticism
Other
Rate the frequency of the following emotions over the past month:
Never | Rarely | Sometimes | Often | Always | |
|---|---|---|---|---|---|
Joy | |||||
Anxiety | |||||
Gratitude | |||||
Loneliness | |||||
Hope | |||||
Anger |
Evaluate the quality of your relationships and social connections.
Number of close friends or family members you can confide in:
Do you feel a sense of belonging in your community?
What would help you feel more connected?
Rate your satisfaction with your current romantic relationship (or most recent one):
Which activities do you engage in to build social connections?
Volunteering
Sports clubs
Religious/spiritual groups
Professional associations
Hobby clubs
Online communities
None
Do you experience persistent conflicts with anyone close to you?
Briefly describe the conflict and how it affects you:
Which statement best describes you?
I follow an organized religion
I am spiritual but not religious
I am agnostic
I am atheist
I am still exploring
Religion or tradition:
Describe your spiritual practices:
My life has meaning and purpose.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Do you engage in regular reflective practices (e.g., journaling, prayer, meditation)?
Describe the practice and its impact on you:
What values guide your decisions and actions?
Assess how your surroundings affect your well-being and how you interact with the planet.
Rate the safety and comfort of your home environment:
Do you have access to green spaces (parks, gardens, nature trails) within 1 km of your home?
How far do you travel to reach green space?
1–5 km
6–15 km
16–30 km
More than 30 km
I rarely visit green space
Which eco-friendly habits do you practice regularly?
Recycling
Composting
Using public transport/biking
Reducing single-use plastics
Conserving water
Supporting sustainable brands
None
Are you concerned about climate change?
How does this concern make you feel?
Which best describes your primary occupational status?
Employed full-time
Employed part-time
Self-employed
Student
Caregiver
Unemployed
Retired
Rate your job satisfaction:
Field of study:
What support would help you find employment?
Do you feel your work aligns with your personal values?
Describe the misalignment:
Select learning activities you engage in regularly:
Reading non-fiction
Online courses
Workshops/conferences
Language learning
Creative hobbies
Professional certifications
None
Rate your proficiency in the following transferable skills:
Beginner | Intermediate | Advanced | Expert | |
|---|---|---|---|---|
Critical thinking | ||||
Digital literacy | ||||
Communication | ||||
Leadership | ||||
Adaptability | ||||
Data analysis |
Understand your relationship with money and financial security.
How would you describe your current financial situation?
I live comfortably within my means
I manage to make ends meet
I occasionally struggle to pay bills
I frequently struggle to pay bills
I am in financial crisis
Would you like resources on budgeting?
Would you like resources on debt management?
Would you like resources on financial assistance?
Do you follow a monthly budget?
What is the main reason?
Lack of time
Lack of knowledge
Irregular income
Feeling restricted
Other
Approximately how much do you save per month?
Rate your confidence in reaching long-term financial goals:
Rate your satisfaction with these life areas:
Physical health | |
Mental health | |
Relationships | |
Career/studies | |
Finances | |
Personal growth | |
Fun/leisure | |
Contribution to society |
Do you have clear short- and long-term goals?
What obstacles prevent you from setting goals?
Imagine your ideal life five years from now. What does it look like?
I believe I can take actions to improve my well-being.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
Let us know how we can support your holistic journey.
Which resources would you find helpful?
Personalized action plan
Coaching/mentoring
Peer support group
Educational workshops
Mobile app
Reading materials
Professional referrals
None
May we contact you in three months for a follow-up assessment?
Preferred contact method (email or phone):
Any additional comments or needs not covered above?
Analysis for Holistic Assessment Form
Important Note: This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes. Please remove this content before publishing the form to the public.
The Holistic Assessment Form excels at delivering a 360-degree life audit across nine inter-connected domains. By blending numeric scales, emotion ratings, conditional logic, and open text, it captures both quantitative trends and rich qualitative nuance in under fifteen minutes. The progressive disclosure pattern—where follow-up questions appear only when relevant—keeps cognitive load low while still allowing deep dives where warranted. A clear introductory consent, section headings, and contextual paragraphs reassure users about data use and set expectations, which is proven to reduce abandonment in self-assessment tools.
From a data-quality standpoint, the form balances comprehensiveness with user burden: only four questions are mandatory, yet branching logic ensures that anyone who opts-in supplies enough detail to generate a meaningful personal report. The use of standardized scales (1–10, Likert, five-point frequency) permits benchmarking against population norms, while the emotion-rating widget adds a differentiated layer that pure Likert scales miss. Matrix questions group related items, cutting repetition and encouraging holistic reflection rather than siloed answers.
Purpose: Establishes explicit GDPR-style consent before any personal health or financial data is captured, protecting both user and provider legally.
Design Strength: Placed right after the welcome paragraph, it acts as a psychological contract—users feel safer disclosing sensitive information once they have transparently agreed to its use.
Data Collection Implication: Without this single checkbox, the entire dataset would be unusable for analytics or reporting; making it mandatory is therefore non-negotiable.
UX Consideration: One-click, above-the-fold consent reduces friction compared with multi-step agreements.
Purpose: Serves as a quick global indicator of physical well-being and a predictor of future health-seeking behaviour.
Strength: The 1–10 numeric scale is intuitive across cultures and correlates well with validated instruments like the SF-36 vitality sub-scale.
Data Quality: Because the scale is anchored only at end-points, users rely on personal reference frames; aggregating large samples still yields normal distributions suitable for segmentation.
UX: A single click on a horizontal scale feels faster than five-point Likert items, improving completion speed on mobile devices.
Purpose: Sleep duration is a cardinal health metric linked to metabolic, cognitive, and emotional outcomes.
Strength: Numeric entry auto-validates to 0–24, preventing implausible values at input time rather than during analysis.
Privacy: While seemingly innocuous, sleep data can indicate stress or chronic illness; keeping it mandatory ensures the wellness algorithm can flag sleep-related risk factors.
UX: Placeholder text and a concise label reduce ambiguity about whether to enter decimals or round numbers.
Purpose: Quantifies social support, one of the strongest predictors of mental health and mortality.
Strength: Open numeric entry avoids ceiling effects seen in three-point categorical scales.
Data Implication: Captures the full range from social isolation (0) to highly connected networks (15+), enabling precise risk stratification.
UX: Users reflect quickly—most can answer in under five seconds—yet the number strongly correlates with longitudinal health outcomes.
The form collects a broad spectrum of personal data—from financial stress to spiritual beliefs—necessitating robust encryption and clear retention policies. By minimizing mandatory fields to only those required for core analytics, the form lowers the psychological barrier to entry while still harvesting sufficient attributes for clustering users into well-being profiles. Optional open-text answers are rich but require NLP pipelines to anonymize named entities before aggregate analysis.
Conditional branching personalises the path: an athlete sees exercise-detail questions, whereas a sedentary user immediately explains barriers, making the form feel relevant and reducing perceived length. Matrix and star-rating components chunk related concepts, leveraging the Gestalt principle of similarity to speed cognition. The final section offers support resources and a voluntary follow-up, creating an off-boarding experience that can nudge users toward action rather than abandonment.
First, the form lacks progress indicators; users cannot gauge how many sections remain, which may inflate drop-off on slower connections. Second, some open numeric fields (e.g., monthly savings) might benefit from currency symbols or locale-based formatting to prevent input errors. Third, spirituality and existential questions may feel sensitive; an optional "prefer not to say" choice could improve inclusivity. Finally, while the matrix questions are efficient, small mobile screens can render them cramped—collapsible accordions or horizontal swipe cards could enhance thumb reachability.
Mandatory Question Analysis for Holistic Assessment Form
Important Note: This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes. Please remove this content before publishing the form to the public.
Question: I consent to the use of my responses for generating a personal holistic report
Justification: Explicit consent is a legal prerequisite for processing special-category data such as health, religious, and financial information under GDPR and many regional privacy acts. Without this checkbox being mandatory, the entire dataset cannot be lawfully stored or analysed, rendering the assessment’s output invalid.
Question: On a scale of 1–10, how would you rate your overall physical energy levels?
Justification: Physical energy acts as a top-line indicator that correlates strongly with multiple downstream domains—sleep, exercise, nutrition, and even mood. Making this item mandatory ensures the algorithm can benchmark users against population norms and trigger targeted recommendations in areas such as fatigue management or exercise planning.
Question: Average hours of sleep per night:
Justification: Sleep duration is a cardinal health metric that predicts cognitive performance, emotional regulation, and long-term disease risk. Capturing it for every participant guarantees that the wellness report can flag sleep-related risk strata and suggest evidence-based interventions (e.g., CBT-I or sleep hygiene) where appropriate.
Question: Number of close friends or family members you can confide in:
Justification: Social-support density is one of the most robust predictors of mental health and mortality. A mandatory response enables the system to identify users at risk of loneliness and proactively recommend community-building resources, coaching, or professional support.
The current strategy of requiring only four core items is exemplary: it secures critical dependent variables while keeping the barrier to entry low. To further optimise completion rates, consider adding a progress bar that dynamically recalculates as optional questions are answered—users often respond to an extra item or two once they see they are "90% done." Additionally, evaluate whether two-step authentication (e.g., email) could be requested after the initial submission rather than at the start, postponing friction until value has already been delivered.
For optional fields that are highly predictive (e.g., dietary pattern or mindfulness frequency), implement soft prompts that appear only when a user hovers on "next" without answering, explaining why the data would enhance their personalised report. Finally, plan periodic reviews of mandatory status: if longitudinal analyses show that a previously optional field significantly improves model accuracy, A/B-test promoting it to mandatory while monitoring drop-off rates to ensure net benefit.
To configure an element, select it on the form.