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Wellness Assessment

Personal Information

Welcome to the 52 Small Changes Assessment (Vegan)!

This assessment looks at three areas of your well-being: Your mental health, physical health and the health of your personal environment. At the end of the assessment, you'll receive an overview that describes which parts of your life are doing well and which could use some improvement.

The assessment takes 10 to 15 minutes to complete. If you start the assessment and find that you don't have time to complete the assessment in its entirety, you can save your progress and continue later by clicking on the link that says "Save and Continue Later" located on the top of the assessment page.

Please be as accurate and honest as possible to ensure valuable and relevant feedback. All information and results will remain confidential.

Email: *This question is required. This question requires a valid email address.

First Name *This question is required.

Last Name *This question is required.

What is your date of birth (we use this to calculate BMI)? *This question is required. (Enter in MM/DD/YYYY)

calendar

Gender: *This question is required.

Are you currently going through or have you gone through menopause? *This question is required.

Are you pregnant? *This question is required.

How far along are you? *This question is required.

What is your height? *This question is required.

Space Cell	Feet	Inches
Height	Feet	Inches

What is your weight (in pounds)? *This question is required. This question requires a valid number format.

Would you like to receive wellness tips and emails from Sheer Balance? *This question is required.

Please note that this assessment is in no way a substitute for medical advice or treatment. In taking this assessment you do not hold Brett Blumenthal or Be Healthy, Inc. liable. The information and questions contained in this assessment are intended to provide helpful and informative material on subjects addressed in 52 Small Changes. It is not intended to serve as a replacement for professional medical advice. Any use of the information in this assessment is at the participant's discretion. The author and publisher specifically disclaim any and all liability arising directly or indirectly from the use or application of any information contained in this assessment. A health-care professional should be consulted regarding your specific situation. You should consult a doctor before embarking on any new health regimen. *This question is required.

By checking this box, which registers you with Brett Blumenthal Studio, you agree to the terms above.