Numerical Holistic Health Census
An anonymous survey for the people analyzed by experts. Only melanated folks can take this census.
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Phone Number *
Email *
Social Media
gender *
Past Medical History: Check themes that apply *
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Please choose the element your Zodiac Sign is connected to.

Fire Signs: Aries (March 21 - April 19) Leo (July 23 - August 22) Sagittarius (November 22 - December 21)

Earth Signs: Taurus (April 20 - May 20) Virgo (August 23 - September 22) Capricorn (December 22 - January 19)

Air Signs: Gemini (May 21 - June 20) Libra (September 23 - October 22) Aquarius (January 20 - February 18)

Water Signs: Cancer (June 21 - July 22) Scorpio (October 23 - November 21) Pisces (February 19 - March 20)

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Please select age range
Clear selection
How many hours of sunlight are you receiving monthly? 

- 1 = basically none on average
- .7 = hardily any on average
- .5 = mediocre on average
.5 =  modestly good
.7 = pretty strong
1 = very strong
Clear selection
What's the quality of your memory?

- 1 = basically none on average
- .7 = hardily any on average
- .5 = mediocre on average
.5 =  modestly good
.7 = pretty strong
1 = very strong
Clear selection
What's the quality of your water intake?

- 1 = basically none on average
- .7 = hardily any on average
- .5 = mediocre on average
.5 =  modestly good
.7 = pretty strong
1 = very strong
Clear selection
What's the quality of your posture?

- 1 = basically none on average
- .7 = hardily any on average
- .5 = mediocre on average
.5 =  modestly good
.7 = pretty strong
1 = very strong
Clear selection
What's the quality of your napping and leisure resting?

- 1 = basically none on average
- .7 = hardily any on average
- .5 = mediocre on average
.5 =  modestly good
.7 = pretty strong
1 = very strong
Clear selection
What's the quality of your friendship interaction? (how often do you ENGAGE?)

- 1 = basically none on average I never engage
- .7 = hardily any on average I barely engage
- .5 = mediocre on average I engage sometimes
.5 =  modestly good I engage on occasion
.7 = pretty strong I engage often
1 = very strong I engage them a lot
Clear selection
How often do you engage with nature? hiking, walking a trail etc ( What's the quality of your nature engagement?)

- 1 = basically none on average I never engage
- .7 = hardily any on average I barely engage
- .5 = mediocre on average I engage seldomly
.5 =  modestly good I engage on occasion
.7 = pretty strong I engage often
1 = very strong I engage a lot
Clear selection
Do you over work? (Are you constantly working? Are you a workaholic?)

1 = Rarely if ever Pretty much I don't
.7 = basically never I rarely do if ever
.5 = On occasion about 6 days a month
- .5 = Seldomly I do sometimes
- .7 = regularly I do often
- 1 = Habitually I always do
Clear selection
How often are you in front of a screen? (Are you on your phone a lot, looking a tv? Are you on a game or in front of your computer on Youtube? This includes work!)

1 = Rarely if ever Pretty much I don't
.7 = basically never I rarely do if ever
 - .2 = Seldomly about 2 hours a day
- .5 =  Occasionally 4 hours a day
- .7 = regularly 4-6 hours a day, often
- 1 = Habitually All the time
Clear selection
Do you procrastinate? (Are you constantly not getting things done? Are you not finishing life's tasks?)

1 = Rarely if ever Pretty much I don't
.7 = basically never I rarely do if ever
.5 = On occasion about 6 days a month
- .5 = Seldomly I do sometimes
- .7 = regularly I do often
- 1 = Habitually I always do
Clear selection
What's the quality of family time? Family dinners or Family meetings (how often do you ENGAGE?)

- 1 = basically none on average I never engage
- .7 = hardily any on average I barely engage
- .5 = mediocre on average I engage sometimes
.5 =  modestly good I engage on occasion
.7 = pretty often I engage often
1 = very strong I engage them a lot
Clear selection
How often do you exercise? Cardio, yoga, gym etc

- 2 = basically none on average I never exercise
- 1.7 = hardily any on average I barely exercise
- 1.3 = mediocre I exercise sometimes
1.3 =  modestly good I exercise on occasionally
1.7 = pretty often I exercise often
2 = very strong I exercise a lot
Clear selection
How often do you stretch? 

- 1 = basically none on average I never stretch
- .7 = hardily any on average I barely stretch
- .5 = mediocre on average I stretch sometimes
.5 =  modestly good I stretch on occasion
.7 = pretty often I stretch often
1 = very strong I stretch a lot
Clear selection
How often do you pray or do spiritual work? 

0 = I don't practice spirituality Its not what I believe
- 1 = basically none on average I never pray
- .7 = hardily any on average I barely pray
- .5 = mediocre on average I pray sometimes
.5 =  modestly good I pray on occasion
.7 = pretty often I pray often
1 = very strong I pray a lot
Clear selection
What's the quality of your weight? 

2 = I have an athletic build I am muscular and strong
1.7 = I'm physically fit I have an athletic build
1.3 = normal weight My weight is n
- 1.3 =  underweight I need more weight
- 1.7 = overweight I am above normal weight
- 2 = obesity I am severely overweight
Clear selection
What is the level of your monthly stress levels? On average how much are you stressed?

1 = Rarely if ever stressed Pretty much I don't at all
.7 = basically never stressed I rarely do if ever
.5 = On occasion I am about 6 days a month
- .5 = Seldomly stressed I am sometimes
- .7 = regularly stressed I am often
- 1 = Habitually stressed I am always
Clear selection
What's your average monthly intake of healthy vegetables? Healthy vegetables that are cooked with slight oil or no oil at all. (not fried vegetables or oil sautéed vegetables) Salads, steamed vegetables, raw vegetables etc. 

- 1 = basically none on average I never eat vegetables
- .7 = hardily any on average I barely eat vegetables
- .5 = mediocre on average sometimes I eat vegetables
.5 =  modestly good on occasion I eat vegetables
.7 = pretty often I often eat vegetables
1 = very strong I eat vegetables a lot
Clear selection
What's your average monthly intake of fruit? 

- 1 = basically none on average I never eat fruit
- .7 = hardily any on average I barely eat fruit
- .5 = mediocre on average sometimes I eat fruit
.5 =  modestly good on occasion I eat fruit
.7 = pretty often I often eat fruit
1 = very strong I eat fruit a lot
Clear selection
What's your average monthly intake of oil? (all types of oils) Any form of oil, any seed or plant oil.

1.3 = basically none on average I never eat oil
1 = hardily any on average I barely eat oil
.7 = mediocre on average seldomly I eat oil
- .7 =  modestly good on occasion I eat oil
- 1 = pretty often I often eat oil
- 1.3 = very strong I eat oil a lot
Clear selection
What's your average monthly intake of sugar? (all types of sugar) Any form of sugar, any food with sugar like cake or pastries or deserts with sugar etc.

1.3 = basically none on average I never eat sugar
1 = hardily any on average I barely eat sugar
.7 = mediocre on average seldomly I eat sugar
- .7 =  modestly good on occasion I eat sugar
- 1 = pretty often I often eat sugar
- 1.3 = very strong I eat sugar a lot
Clear selection
What's your average monthly intake of salt? (all types of salt) Any form of salt, any food with salt like fries, snacks, wings or any dish with salt in it etc.

1.3 = basically none on average I never eat salt
1 = hardily any on average I barely eat salt
.7 = mediocre on average seldomly I eat salt
- .7 =  modestly good on occasion I eat salt
- 1 = pretty often I often eat salt
- 1.3 = very strong I eat salt a lot
Clear selection
What's your average monthly intake of meat? (all types of meat) Any form of meat, any food with meat in it, fish, wings or any dish with meat in it etc.

1.3 = basically none on average I never eat meat
1 = hardily any on average I barely eat meat
.7 = mediocre on average seldomly I eat meat
- .7 =  modestly good on occasion I eat meat
- 1 = pretty often I often eat meat
- 1.3 = very strong I eat meat a lot
Clear selection
What's your average monthly intake of diary? (all types of diary) Any form of diary, any food with diary in it, milk, cheese or any dish with diary in it etc.

1.3 = basically none on average I never eat diary
1 = hardily any on average I barely eat diary
.7 = mediocre on average seldomly I eat diary
- .7 =  modestly good on occasion I eat diary
- 1 = pretty often I often eat diary
- 1.3 = very strong I eat diary a lot
Clear selection
How often do you emotionally eat on average monthly?  Emotional eating is eating as a way to suppress or soothe negative emotions, such as stress, anger, fear, boredom, sadness and loneliness.

1.3 = basically none on average I never do this
1 = hardily any on average I barely emotionally eat
.7 = mediocre on average seldomly I do
- .7 =  modestly good on occasion I do
- 1 = pretty often I often emotionally eat
- 1.3 = very strong I emotionally eat a lot
Clear selection
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