Wellness Coaching Assessment Form

Wellness Coaching Assessment Form

Ivy Tech Evansville students interested in wellness coaching can complete this form to get started. You’ll be contacted as soon as possible after submission.
Section 1: Contact Information
Preferred method of contact:
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Section 2: Physical Wellness
Caring for your body through activity, nutrition, and sleep.

I get regular physical activity (150+ min/week).
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I eat balanced, nutritious meals most days.
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I get adequate sleep (7-9 hours/night).
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Would you like help improving your physical wellness?
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Readiness to change
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Section 3: Emotional Wellness
Managing stress, emotions, and mental health support.

I manage stress effectively.
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I have healthy coping strategies.
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Would you like help with emotional wellness?
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Readiness to change
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Section 4: Financial Wellness
Budgeting, saving, and managing financial stress.
I maintain a monthly budget.
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I feel in control of my finances.
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Would you like help with financial wellness?
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Readiness to change
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Section 5: Occupational Wellness
Satisfaction with work, studies, or career direction.
I feel fulfilled by my work or studies.
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I'm confident about my career path.
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Would you like help with career or time management?
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Readiness to change
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Section 6: Intellectual Wellness
Pursuing learning, curiosity, and mental growth.
I regularly challenge myself intellectually.
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I'm engaged in learning or creative pursuits.
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Would you like help with study habits or motivation?
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Readiness to change
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Section 7: Social Wellness
Building connections and support networks.
I have positive relationships and support.
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I feel comfortable asking for help.
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Would you like help with social wellness?
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Readiness to change
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Section 8: Spiritual Wellness
Exploring meaning, values, mindfulness, or purpose
I feel connected to a sense of purpose.
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I practice reflection or meditation.
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Would you like help with spiritual wellness?
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Readiness to change
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Section 9: Environmental Wellness
Creating healthy, supportive environments and sustainable habits.
I feel safe and comfortable in my environment.
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I regularly spend time in nature or make eco-conscious choices.
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Would you like help improving your environment?
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Readiness to change
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Section 10: Creative Wellness
Expressing yourself through art, hobbies, or creative outlets.
I participate in creative activities that relax me.
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I make time for hobbies or self-expression.
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Would you like help exploring your creativity?
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Readiness to change
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Final Section: Goals & Coaching Interest
Would you like to schedule a 1-on-1 session with a Wellness Coach?
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