WELLTHINESS
BY MICA

Whole-Life Balance Assessment

A client intake & check-in tool for coaching, informed by Blue Zones' Power 9, the MIND & Mediterranean-DASH diets, ACLM (American College of Lifestyle Medicine) resources, and core mental health screening measures.

For each statement, select the number that best reflects your life over the past 2–4 weeks. There are no right or wrong answers — this is simply a snapshot to help guide our work together.

This tool is educational and for coaching purposes only. It is not a diagnostic instrument and does not replace evaluation by a licensed medical or mental health professional. This assessment is meant to capture an honest, judgment-free snapshot of your day-to-day life — it is in no way intended to invoke negative feelings about yourself or your lifestyle. If any responses raise concern for your safety, please contact a licensed provider or crisis line right away.

1 · Blue Zones — Power 9 Lifestyle Habits

These questions reflect longevity habits observed in the world's "Blue Zones" — the places people live longest, healthiest lives.

Scale: 0 = Never   1 = Rarely   2 = Sometimes   3 = Often   4 = Always

I move naturally throughout my day (walking, gardening, taking stairs) without relying only on formal exercise.

I have a clear sense of purpose that motivates me to get up each morning.

I have a daily practice that helps me release stress (prayer, meditation, rest, unplugging).

I belong to a faith-based, social, or community group that I engage with regularly.

I prioritize my family and closest relationships ahead of work or other obligations most days.

2 · Anxiety Check-In

Over the last 2 weeks, how often have you been bothered by the following?

Scale: 0 = Not at all   1 = Several days   2 = More than half the days   3 = Nearly every day

Feeling nervous, anxious, or on edge.

Not being able to stop or control worrying.

Trouble relaxing.

Feeling restless, so that it is hard to sit still.

Feeling afraid, as if something awful might happen.

3 · Coping Strategies & Self-Care

Reflect on how you typically respond to stress and difficult emotions, and how you relate to self-care.

Scale: 0 = Never   1 = Rarely   2 = Sometimes   3 = Often   4 = Always

When stressed, I use healthy tools (breathing, journaling, movement, talking it through).

I can identify and name what I am feeling in the moment.

I reach out to a trusted person when I am struggling, rather than isolating.

I use food, alcohol, shopping, or screens to numb or avoid difficult emotions.

I feel equipped to handle unexpected stress or setbacks.

I make time for self-care practices (rest, hobbies, movement, boundaries) even during busy or stressful weeks.

I view self-care as a necessity rather than a luxury or something I need to earn.

I can name at least one self-care practice that consistently helps me feel restored.

Item 4 is reverse-scored automatically — a lower frequency of numbing behavior contributes to a healthier total.

4 · Physical Health Habits

Rate how true each statement is for your current routine.

Scale: 0 = Never   1 = Rarely   2 = Sometimes   3 = Often   4 = Always

I get moderate-to-vigorous exercise (heart rate raised) at least 3 times per week.

I spend time outside in daylight or fresh air most days.

I drink adequate water daily (roughly half my body weight in ounces).

I keep up with preventive care (annual physical, dental, and recommended screenings).

I limit recreational sitting/screen time to fewer than 3 hours per day.

5 · Eating Habits (MIND & Mediterranean-DASH)

These questions draw from the MIND and Mediterranean-DASH eating patterns, both linked to brain and heart health.

Scale: 0 = Never   1 = Rarely   2 = Sometimes   3 = Often   4 = Always

I eat leafy greens plus at least one other vegetable daily.

I eat berries and/or nuts several times a week.

I choose whole grains (quinoa, brown rice, oats, etc.) over refined grains (white bread, white rice) most of the time.

I eat fish at least once a week and limit red meat to a few times a month or less.

I limit fried food, fast food, pastries, and added sugar to a few times a week or less.

6 · Sleep Hygiene

Rate how true each statement is for your typical week.

Scale: 0 = Never   1 = Rarely   2 = Sometimes   3 = Often   4 = Always

I go to bed and wake up at consistent times, even on weekends.

I get 7–9 hours of sleep on most nights.

I avoid screens or blue light for at least 30 minutes before bed.

My bedroom is dark, cool, quiet, and used mainly for sleep.

I limit caffeine intake after early afternoon (before ~2 pm).

7 · Environmental Factors, Medications, Supplements & Substance Use

Please answer as completely as you can — this information is confidential and helps me support you safely.

8 · Additional Considerations

Please list any injuries or medical diagnoses — past or current — that may be relevant to how we design your game plan. This helps us build a plan that works with your body, not against it.

9 · Healthy Aging Considerations

These questions reflect common age-related shifts in balance, memory, purpose, and energy, drawn from WHO healthy-aging (ICOPE) domains, CDC fall-risk and memory screening, and longevity research on sense of purpose.

Scale: 0 = Never   1 = Rarely   2 = Sometimes   3 = Often   4 = Always

I feel steady on my feet and confident in my balance and mobility, without a significant fear of falling.

Over the past year, I have not noticed increased confusion or memory lapses that concern me.

I feel I have meaningful roles, goals, or reasons to get up each day at this stage of my life.

I have enough energy and appetite to do the things that matter to me most days.

I feel engaged with life and connected to people, activities, or communities that matter to me.

Your Wellthiness Snapshot

A summary of today's check-in.

DomainScoreReflection

Environmental Factors, Medications, Supplements & Substance Use

Additional Considerations

Want to share these results with Mica and go deeper with a personalized plan?

Then, when you're ready, schedule your consultation:

Schedule a consultation

Sources & Evidence Base

This assessment draws on the following established research frameworks and clinical resources.

Blue Zones — Power 9

Dan Buettner's Blue Zones research (National Geographic–funded demographic studies of the world's longest-lived populations: Okinawa, Sardinia, Nicoya, Ikaria, and Loma Linda). The Power 9 synthesizes nine shared lifestyle habits across these regions — natural movement, purpose, stress downshifting, the 80% rule, plant slant, wine at 5, belonging, loved ones first, and right tribe.

Anxiety Check-In

Adapted from the GAD-7 (Generalized Anxiety Disorder 7-item scale), developed by Spitzer, Kroenke, Williams, and Löwe (2006), Archives of Internal Medicine — a widely validated brief anxiety screening tool used in primary care and behavioral health settings.

Coping Strategies & Self-Care

Coping items are grounded in cognitive-behavioral therapy (CBT) principles distinguishing adaptive coping (problem-solving, social support, emotional processing) from maladaptive coping (avoidance, numbing, substance use), as established in Lazarus & Folkman's transactional model of stress and coping. Self-care items reflect research on self-care as a distinct construct from general coping — how consistently it's practiced and whether it's perceived as a necessity versus an indulgence — which shapes whether people sustain it under stress.

Physical Health Habits

Informed by CDC/WHO physical activity and preventive care guidelines, and by ACLM (American College of Lifestyle Medicine) pillars, which recognize physical activity and regular preventive care as core lifestyle medicine domains.

Eating Habits — MIND & Mediterranean-DASH

MIND diet developed by Martha Clare Morris and colleagues at Rush University Medical Center, combining Mediterranean and DASH principles to target brain health. DASH originated from NIH-funded clinical trials; the Mediterranean pattern is supported by decades of cardiovascular research (e.g., the PREDIMED trial). Both are core nutrition pillars within ACLM's lifestyle medicine framework.

Sleep Hygiene

Based on sleep hygiene guidance from the CDC, National Sleep Foundation, and American Academy of Sleep Medicine — covering consistent sleep/wake timing, 7–9 hours nightly, blue-light reduction before bed, sleep environment, and caffeine timing.

Environmental Factors, Medications, Supplements & Substance Use

Structured as a general intake inventory rather than a scored instrument, informed by standard clinical medication/supplement reconciliation practices and substance-use screening conventions consistent with SAMHSA and NIAAA guidance on alcohol quantity thresholds and substance use disclosure categories.

Additional Considerations

Structured as a general intake inventory rather than a scored instrument, informed by pre-activity readiness screening practices such as the Physical Activity Readiness Questionnaire (PAR-Q+) and standard clinical intake norms for reviewing injury and medical history before designing an exercise or lifestyle plan.

Healthy Aging Considerations (60+)

Drawn from the World Health Organization's Integrated Care for Older People (ICOPE) framework, which screens intrinsic capacity across mobility, cognition, vitality, and psychological domains; the CDC's STEADI fall-risk initiative and its core balance/falls questions; the CDC's subjective cognitive decline (SCD) module, which asks about worsening confusion or memory loss over the past year; and longevity research on sense of purpose in older adults (e.g., Kim, Hill, and colleagues), linking a strong sense of purpose to healthier, longer life.