Personalized Coaching
Assessments and Forms

This page contains the assessments and forms we need to kick off your personalized coaching and includes step-by-step instructions to assist you.

Before we begin, it’s best if your coach knows more about your health history and habits.

Your coach will let you know which forms are most important for getting started.

Fill out the following forms as accurately as possible.

Each time you complete an online form, you will receive a receipt copy of your submission to your inbox.

As you complete each assessment, please forward your receipt copy to your assigned coach.

Health and Habits “Get to Know You” Questionnaire: This is where your coach will get to know you as you share what your goals are, what your current obstacles are, and how you can work together to make it all right. If you have recently completed a Strategy Session with Dr. Ritamarie or one of her coaches, you can ask your coach to use the previously submitted assessment as it’s the same form.
Past and Present Health, Trauma, and Family History Assessment: By looking at your past and family history, it’s possible to ascertain what imbalances you bring from early exposures and genetics.

Dietary Habits Assessment: This is a thorough survey of your food habits and preferences.
Diet, Medication/Supplement, Activity, and Mood/Symptom Daily Diary: Here’s a way to record what you eat and what you take. If you prefer, you can use an excel spreadsheet version, which allows for tracking on an ongoing basis. Click HERE to download the excel spreadsheet version of the diet, medication, and supplements tracking form. You can then e-mail to your coach or upload using the uploader form located HERE

You’ll receive a color coded analysis by email right after you complete each of these evaluations.

Body Systems and Organs Assessment: A thorough symptom survey of your organs and body systems. This health assessment will examine your digestion (5 parts), cardiovascular, kidney and bladder, and immune system health. Each body system will receive a score.
Hormones and Glands Assessment: This health assessment will examine your hormone balance (11 parts). Each organ and gland will receive a score.

Nutrient Balance: General Assessment: This health assessment will examine your general nutritional needs, essential fatty acid needs, and potential levels of amino acids.
Nutrient Balance: Vitamin Assessment: This health assessment will examine your potential levels of vitamins including A, B, B1, B2, B3, B5, B6, B7, B9, B12, and C.
Nutrient Balance: Mineral Assessment: This health assessment will examine your potential levels of minerals including calcium, chromium, copper, iodine, iron, magnesium, manganese, phosphorus, potassium, and zinc.

Brain and Neurotransmitter Assessment: This health assessment will examine your general brain function, serotonin, dopamine, GABA, and acetylcholine. Recommended if history of anti-depressant or other brain drugs or “brain” symptoms.
Candida and Gut “Dysbiosis” Assessment: A set of questions to determine your likelihood of candida or related digestive imbalances.
Detoxification Stress/Toxicity Assessment: This health assessment will measure your level of toxicity by examining conditions related to your digestion, ears, head, heart, emotions, joints/muscles, energy/activity, lungs, eyes, mind, skin, mouth/throat, weight, nose, and other indicators.

Lab Testing Page: If you have any lab results for the past year, there’s a place towards the bottom of the where you can download a spreadsheet and fill-in your results. There are currently 4 columns of dates possible and this can be expanded as needed. This spreadsheet will be an invaluable tool for you in monitoring your health over the years. This page will guide you to determine what labs to get if you have no labs. You can either get the basics done as described or submit your assessment forms and get my assistance with determining the best place to start.
Master Health Tracker (XLSX): A complete set of spreadsheets to help you track your health and lab work over time.
(Save and then make a COPY to work from)