Integrative Psychiatrist

 
Holistic Questionnaire Part One:  

0 = Never or almost never (once a year or less)
1 = Seldom (2 to 12 times a year)
2 = Occasionally (2 to 4 times a month)
3 = Often (2 to 3 times a week)
4 = Regularly (4 to 6 times a week)
5 = Daily (every day)

 

BODY: Physical and Environmental Health

 

1 Do you maintain a healthy diet: low fat, low sugar, fresh fruits, grains and vegetables?
2 Is your water intake adequate (at least ½ oz./lb. of body weight; 160 lbs. = 80 oz.)?
3 Are you within 20 percent of your ideal body weight ?
4 Do you feel physically attractive ?
5 Do you fall asleep easily and sleep soundly?
6 Do you awake in the morning feeling well rested?
7 Do you have more than enough energy to meet your daily responsibilities ?
8 Are your five senses acute ?
9 Do you take time to experience sensual pleasure ?
10 Do you schedule regular massage or deep-tissue body work ?
11 Does your sexual relationship feel gratifying ?
12 Do you engage in regular physical workouts lasting at least 20 minutes ?
13 Do you have good endurance or aerobic capacity ?
14 Do you breathe abdominally for at least a few minutes ?
15 Do you maintain physically challenging goals ?
16 Are you physically strong ?
17 Do you do some stretching exercises ?
18 Are you free of chronic aches, pains, ailments and diseases ?
19 Do you have regular effortless bowel movements ?
20 Do you understand the causes of your chronic physical problems ?
21 Are you free of any drug or alcohol dependency (including nicotine and caffeine) ?
22 Do you live in a healthy environment with respect to clean air, water and indoor pollution ?
23 Do you feel energized or empowered by nature ?
24 Do you feel a strong connection with and appreciation for your body, your home and your environment ?
25 Do you have an awareness of life-energy or qi ?