Name
Email
How long have you been diagnosed with MS? Less than 1 year
1-5 years
6-10 years
More than 10 years
How would you describe your current MS symptoms? Mild with occasional flare-ups
Moderate but manageable
Severe and impacting daily life
Remission or symptom-free
How do you currently manage your MS symptoms? Primarily through medication
Through a mix of medication and lifestyle changes
Mostly through holistic or natural methods
I’m exploring alternative approaches but haven’t found the right one yet
How would you describe your diet? I eat mostly processed and convenience foods
I try to eat healthy, but I find it difficult to stick to it
I eat a balanced diet with whole, unprocessed foods
I follow a strict whole-food, plant-based diet
How often do you exercise? Rarely or never
Occasionally, when I feel up to it
I exercise a few times a week
I exercise regularly, making it a part of my routine
How do you manage stress? I often feel overwhelmed and don’t have stress management techniques
I have a few strategies but could use more support
I regularly practice techniques like meditation or breathing exercises
I rarely feel stressed and have solid management techniques in place
What is your sleep routine like? I have trouble falling or staying asleep most nights
My sleep is inconsistent, but I get by
I generally get good sleep, but there’s room for improvement
I sleep well and consistently every night
How would you rate your energy levels throughout the day? I often feel fatigued and low-energy
My energy levels fluctuate, with highs and lows
I generally have consistent energy throughout the day
I feel energized and rarely experience fatigue
How much sunlight exposure do you get daily? I spend most of my time indoors
I get occasional sunlight but not consistently
I try to get some sunlight most days
I make it a priority to get regular sunlight exposure every day
How important is building healthy habits to you? I’m not sure how to build healthy habits
I want to build healthy habits but struggle to stick to them
I’m actively trying to create better habits in my life
I have built many healthy habits and am consistent with them
How would you describe your support system (family, friends, community)? I feel isolated and lack a strong support system
I have some support, but it’s not as strong as I would like
I have a good support system but could strengthen it
I have a solid, supportive community around me
What is your experience with mindfulness or meditation practices? I’ve never tried mindfulness or meditation
I’ve tried it a few times but don’t practice regularly
I practice mindfulness or meditation occasionally
I have a regular mindfulness or meditation practice
How do you feel about the role of spirituality or faith in your wellness journey? I don’t consider spirituality or faith in my wellness
I believe spirituality or faith could help, but I haven’t focused on it
I actively incorporate spirituality or faith into my life
My faith or spirituality plays a central role in my overall well-being
How comfortable are you with making significant lifestyle changes? I’m hesitant to make big changes
I’m open to some changes but nervous about how it will affect me
I’m ready to make changes but need guidance
I’m fully committed to transforming my lifestyle for better health
How do you feel about working with a coach to achieve your goals? I’ve never worked with a coach and am unsure if it’s for me
I’m curious but unsure if coaching is the right fit for me
I’m ready to work with a coach but want to make sure it’s the right partnership
I’m eager and ready to work with a coach to transform my life
Is there anything else you would like me to know?
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