My Lifestyle Today:
A Wellness Approach

My Lifestyle Today

This approximate 10 minute reflection is a simple way to pause, notice your current daily rhythm, and bring greater clarity to what may be supporting your well-being… and what may benefit from thoughtful attention.

Your responses help HIW better understand your sleep, nourishment, hydration, movement, energy, stress, digestion, social support, creativity, downtime, supplementation awareness, and overall consistency.

This form may be completed before beginning HIW support and revisited later to notice what has shifted, what feels stronger, and what may benefit from continued support.

Please answer based on your current reality. There are no right or wrong answers… only useful information.

Basic Information

First Name

Last Name

WhatsApp Phone Number

Some wellness considerations can vary by life stage. Knowing your approximate age helps HIW offer educational support that is more relevant to your current season of life.

When are you completing this reflection?

Current Lifestyle Snapshot

For the following questions, please choose the answer that feels most accurate today.

How supportive does your eating pattern feel right now?

Conscientious Supplementation Awareness

HIW may provide educational information about nutritional and herbal supplementation when relevant. There are no right or wrong answers here. This simply helps us understand whether supplementation is part of your current lifestyle rhythm, something you would like to understand better, or something you prefer not to discuss at this time.

HIW does not prescribe supplements. Supplementation education is always considered within the larger context of nourishment, lifestyle rhythm, safety, medications, quality, purpose, and guidance from qualified healthcare providers.

Are you currently using nutritional, herbal, or other wellness supplements?

If you selected "Other", you may briefly share what feels most relevant.

Relationship With Supplementation

What best describes your current relationship with supplementation?

I use supplements with a clear purpose

I take some but am unsure if they are still relevant

I feel overwhelmed by supplement information

I tend to reach for supplements before addressing food or lifestyle rhythm

I prefer to focus on food and daily habits first

I would like science-informed education before making decisions

I am unsure

Prefer not to answer

Supplementation Education

Safety note: Please consult with a qualified healthcare provider regarding medications, medical symptoms, pregnancy, breastfeeding, health conditions, or before beginning, stopping, or combining supplements, herbs, or natural products.

Movement, Energy, Stress, Digestion & Consistency

Movement

Energy

How would you describe your energy during the day?

Stress & Emotional Load

Emotional Steadiness

How emotionally steady do you feel most days?

Digestion, Gut Comfort & Elimination

How comfortable does your digestion feel most days?

How comfortable does your elimination rhythm feel most days?

If you selected “Other,” you may briefly share what feels most relevant.

Daily Consistency

How consistent do your wellness-supportive habits feel right now?*

Pattern Recognition

When You Feel Out of Balance

Current Strengths

Growth Areas

Social Connection & Support

Creativity, Meaningful Activity & Self-Expression

Downtime, Recovery & Reset Space

Priority Clarifier

Reflection Questions

What feels most important for you to support right now?

Regarding your wellness, in one sentence, what would you like to feel more of in your daily life?

If you have completed this form before, what feels different since last time?

Is there anything else you would like HIW to know about your current lifestyle rhythm, responsibilities, stress, energy, sleep, nourishment, supplementation questions, or support needs?

Acknowledgement, Understanding & Agreement

I have read, understood, and agree.

I confirm that I am 18 years of age or older. I understand and agree that use of this form, HIWLive.com, and any HIW services, programs, resources, or materials I choose to access is subject to the HIW policies, agreements, and terms linked below and/or available in the website footer.

Privacy Policy – Code of Conduct – Participant Waiver & Educational Coaching Agreement – Terms & Conditions Policy – User License – Disclaimer – Forms Disclaimer

I understand that HIW Live is operated by HIW LLC. HIW LLC provides professional, educational, wellness-focused guidance and supportive services. HIW LLC does NOT diagnose, treat, prescribe, nor replace licensed medical, mental health, or other professional care.

I understand that any decisions regarding my health and well-being remain my responsibility, and that the information I provide is accurate to the best of my knowledge.

Thank you.