Synchronicity Tasmania - Integrated Wellness Survey

1. Tell us about your General Health and Wellbeing

Synchronicity Tasmania specialises in providing integrated health and wellness coaching services to those in the veteran community and their families. A few minutes of your time to complete this survey about overall health and wellbeing would be really appreciated. All questions are optional and all answers will be held in the strictest confidence.

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* 1. In general, how would you rate your overall health and wellbeing?

Excellent

Very good

Good

Fair

Poor

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* 2. What best describes your current profile?

I am a veteran/returned service person

My spouse/partner is a veteran/returned service person

I am the child of a veteran/returned service person

I am a currently serving member of the defence force

Other (please specify)

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* 3. What factors are important to you in maintaining a balanced lifestyle? (please tick all that are appropriate)

Physical fitness

Mental health

Healthy eating

Spending time with family

Spending time with friends

Financial security

Personal relationships

Intimacy

Creativity

Spirituality

Other (please specify)

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* 4. Please indicate how balanced you feel each in area of your life listed below:

	Always balanced	Balanced most of the time	Balanced sometimes	Not balanced much of the time	Completed unbalanced
Physical fitness	Physical fitness Always balanced	Physical fitness Balanced most of the time	Physical fitness Balanced sometimes	Physical fitness Not balanced much of the time	Physical fitness Completed unbalanced
Mental health	Mental health Always balanced	Mental health Balanced most of the time	Mental health Balanced sometimes	Mental health Not balanced much of the time	Mental health Completed unbalanced
Healthy eating	Healthy eating Always balanced	Healthy eating Balanced most of the time	Healthy eating Balanced sometimes	Healthy eating Not balanced much of the time	Healthy eating Completed unbalanced
Spending time with family	Spending time with family Always balanced	Spending time with family Balanced most of the time	Spending time with family Balanced sometimes	Spending time with family Not balanced much of the time	Spending time with family Completed unbalanced
Spending time with friends	Spending time with friends Always balanced	Spending time with friends Balanced most of the time	Spending time with friends Balanced sometimes	Spending time with friends Not balanced much of the time	Spending time with friends Completed unbalanced
Financial security	Financial security Always balanced	Financial security Balanced most of the time	Financial security Balanced sometimes	Financial security Not balanced much of the time	Financial security Completed unbalanced
Personal relationships	Personal relationships Always balanced	Personal relationships Balanced most of the time	Personal relationships Balanced sometimes	Personal relationships Not balanced much of the time	Personal relationships Completed unbalanced
Intimacy	Intimacy Always balanced	Intimacy Balanced most of the time	Intimacy Balanced sometimes	Intimacy Not balanced much of the time	Intimacy Completed unbalanced
Creativity	Creativity Always balanced	Creativity Balanced most of the time	Creativity Balanced sometimes	Creativity Not balanced much of the time	Creativity Completed unbalanced
Spirituality	Spirituality Always balanced	Spirituality Balanced most of the time	Spirituality Balanced sometimes	Spirituality Not balanced much of the time	Spirituality Completed unbalanced

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* 5. Reflecting on your answers in Questions 2 & 3 - if given the opportunity, what are the two main areas in which you feel you would like to achieve more balance and why?

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* 6. What are the main factors which make it difficult for you to maintain a healthy and balanced lifestyle?

Busy work environment

Too many competing priorities

Lack of time

Lack of knowledge on how to do this

Level of support from family

Lack of motivation

Mental self-talk

Lack of physical fitness

Poor food choices

Financial pressures

I am not sure

Other (please specify)

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* 7. How physically healthy are you?

Extremely healthy

Very healthy

Somewhat healthy

Not so healthy

Not at all healthy

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* 8. How important is exercise to you?

Extremely important

Very important

Somewhat important

Not so important

Not at all important

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* 9. In general, how would you rate your overall mental or emotional health?

Excellent

Very good

Good

Fair

Poor

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* 10. Would you seek help from a Health Coach to assist you in developing your personal blueprint for achieving more balance in the areas you have identified?

Yes

Maybe

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* 11. Would you be willing to pay for this service?

Yes

Perhaps

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* 12. How much would you be willing to pay to work with a Health & Wellness Coach to find long-term balance in your overall health & wellbeing?

$150 - $300 per month

$301 - $500 per month

Over $500 per month

Other (please specify how much you would be willing to pay per month)

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* 13. What is your age group?

Under 25

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 14. Are you male or female?

Male

Female

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* 15. (OPTIONAL) If you would like to discuss your answers or provide additional feedback, please provide your contact details below.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number