Pre-Transformation Assessment

Well-being Evaluation Questionnaire —

Pre-Transformation Assessment

Complete your pre-transformation well-being assessment. This confidential questionnaire helps us customize your 8-day Oasis-Office intensive to your unique needs, priorities, and goals.

H1: Well-being Evaluation Questionnaire

Canonical: oasis-office.org/well-being-evaluation-questionnaire

Before Your 8-Day Transformation

Welcome. We're glad you're here.

This questionnaire is your starting point—a snapshot of where you are now, physically, emotionally, and energetically. It helps us understand what matters most to you and how to design your 8-day intensive around your unique needs.

What happens next:

You complete this assessment — takes 10–15 minutes, done privately

Ni Wa reviews your responses — in person, confidentially, with care and respect

You receive personalized feedback — an 8-minute one-on-one session where we discuss your results, set realistic goals, and establish your transformation roadmap

Your 8-day intensive begins — customized entirely around what you've shared

About confidentiality: Everything you share is held in confidence. This is your space to be honest about where you are. No judgment. Only clarity, care, and forward movement.

Your Information

Name:

Organization/Company:

Role/Position:

Email:

Phone:

Date:

1. Physical Well-being

Overall Health

On a scale of 1–8, how would you rate your overall physical health?

1 = Poor | 8 = Excellent

[ ]

Current Physical Concerns

Do you experience any pain or discomfort in your body? (Check any that apply)

[ ] Neck or shoulder tension

[ ] Lower back pain

[ ] Headaches or migraines

[ ] Joint pain

[ ] Fatigue or heaviness

[ ] Other: _______________

[ ] No pain or discomfort

Medication or Health Conditions

Are you currently managing any health conditions or taking medication? (Yes/No)

If yes, please describe briefly:

Hydration

On average, how many glasses of water do you consume daily?

[ ] 1–2 glasses

[ ] 3–4 glasses

[ ] 5–6 glasses

[ ] 7+ glasses

Nutrition

How many servings of whole fruits or vegetables do you typically consume in a day?

[ ] 0–1 servings

[ ] 2–3 servings

[ ] 4–5 servings

[ ] 6+ servings

2. Physical Activity & Movement

Current Activity Level

Do you participate in any sports or regular physical activities? (Yes/No)

If yes, what activities and how often?

Select: daily | weekly | monthly | occasionally

Activity: ___________________ Frequency: [ ]

Work & Commute Movement

How do you primarily commute to work?

[ ] Car

[ ] Public transportation

[ ] Biking

[ ] Walking

[ ] Other: _______________

If you commute by car, do you take breaks to stretch or move during your commute?

[ ] Yes, regularly

[ ] Occasionally

[ ] No

3. Caffeine, Sugar & Stimulants

Caffeine Consumption

Do you consume caffeine (coffee, tea, energy drinks, etc.)? (Yes/No)

If yes, how many cups or servings daily?

[ ] 1–2

[ ] 3–4

[ ] 5 or more

Sugar & Sweeteners

Do you add sugar or sweeteners to coffee, tea, or other beverages? (Yes/No)

If yes, approximately how many teaspoons per day?

[ ] 1–2 teaspoons

[ ] 3–5 teaspoons

[ ] 6+ teaspoons

Smoking or Nicotine

Do you use tobacco or nicotine products? (Yes/No)

If yes, frequency: _______________

4. Emotional Well-being & Balance

Overall Happiness

On a scale of 1–8, how would you rate your overall happiness right now?

1 = Very unhappy | 8 = Very happy

[ ]

Current Stress Level

On a scale of 1–8, how would you rate your current stress level?

1 = Minimal stress | 8 = Overwhelmed

[ ]

Well-being Practices

Which of the following practices do you currently engage in regularly? (Check all that apply)

[ ] Yoga or stretching

[ ] Breathing exercises or meditation

[ ] Mindfulness or reflection

[ ] Time in nature

[ ] Time with family or close friends

[ ] Journaling or creative expression

[ ] Walking or outdoor movement

[ ] Other: _______________

[ ] None of these regularly

Nature & Sunlight

How often do you spend time in nature (parks, gardens, outdoor spaces)?

[ ] Daily

[ ] Weekly

[ ] Monthly

[ ] Rarely

Do you consciously spend time in natural sunlight? (Yes/No)

5. Creative Expression & Growth

Creative Life

Do you engage in creative activities or hobbies outside of work? (Yes/No)

If yes, what do you enjoy creating or expressing?

Professional Growth

What specific skills, knowledge, or experiences would you like to develop during your transformation?

Examples: leadership, communication, resilience, new skills, deeper focus, etc.

6. Goal-Setting & Vision

Current Goals

Do you set personal or professional goals for yourself? (Yes/No)

If yes, how often do you revisit and evaluate your progress?

[ ] Daily

[ ] Weekly

[ ] Monthly

[ ] Yearly

[ ] Rarely

Your 8-Day Intention

What is your primary goal or desired outcome from this 8-day intensive?

7. Energy Patterns

Rate your energy levels across the day (1 = very low energy | 8 = excellent energy):

Morning Energy

On average, how is your energy when you wake up or arrive at work?

1 = Depleted | 8 = Energized

[ ]

Midday/Afternoon Energy

How is your energy during the afternoon?

1 = Post-lunch crash | 8 = Strong and focused

[ ]

Evening Energy

How is your energy in the evening?

1 = Exhausted | 8 = Energized

[ ]

Energy Patterns

When do you notice your energy dips or peaks during the day?

8. Workplace Environment & Culture

Current Workspace

How satisfied are you with your current work environment?

1 = Very dissatisfied | 8 = Very satisfied

[ ]

What Would Help Most?

Which of these would be most valuable for you and your organization? (Select top 3)

[ ] Flexible working hours or 4-day workweek

[ ] Remote work opportunities

[ ] Wellness programs and resources

[ ] Better physical workspace design (lighting, plants, ergonomics)

[ ] Quiet focus zones or privacy

[ ] Stronger team connection and community

[ ] Better work-life balance support

[ ] Healthier food options or nutrition guidance

[ ] Mental health or stress-management support

[ ] Professional development opportunities

[ ] Other: _______________

9. Top 3 Priorities

What are the three areas you'd most like to focus on during your 8-day intensive?

Please rank them by importance:

1. _______________________________________________________________

2. _______________________________________________________________

3. _______________________________________________________________

Final Reflection

Is there anything else we should know to make your transformation experience meaningful?

Confidentiality & Privacy

Your responses are completely confidential and will be used only to customize your 8-day intensive experience. We respect your privacy and treat your information with care and discretion.

By completing this assessment, you agree that your responses may be reviewed in person with Ni Wa (Holistic Physiotherapist, Oasis-Office founder) for the purpose of creating a personalized transformation plan.

Thank you for taking the time to complete this assessment.

Your honesty and reflection are the foundation for real, lasting change.

See you soon.

— Oasis-Office

How to Submit

Complete this form online: [Link to form]

Download and print this questionnaire, complete it by hand, and email it to: [email@oasis-office.org]

Please submit at least 3 days before your 8-day intensive begins.

SEO Metadata

Page Title (60 chars): Well-being Evaluation Questionnaire — Pre-Transformation

Meta Description (155 chars): Complete your confidential pre-transformation assessment. This questionnaire helps us customize your 8-day Oasis-Office intensive to your unique needs.

H1: Well-being Evaluation Questionnaire

Primary Keywords: well-being assessment, pre-transformation questionnaire, wellness evaluation, holistic health assessment, employee well-being

Secondary Keywords: workplace wellness, physical health evaluation, emotional well-being, energy assessment, confidential health questionnaire

Internal Links:

Link to "How It Works" (methodology)

Link to "The 8-Day Intensive" or pricing page

Link to "Contact & Book" (booking CTA)

Call-to-Action: "Complete this form online" or "Download and email"

Canonical URL: oasis-office.org/well-being-evaluation-questionnaire

Schema Markup (optional): Add Form schema for SEO crawlers to recognize this as an assessment tool

Notes for JouwWeb Implementation

For Online Form: Integrate with Typeform, Google Forms, or Jotform (emails response directly to you)

For PDF Download: Create a downloadable .pdf version of this questionnaire

Page Position: Can live in Learn Hub as a resource, or as a gated page (requires email to download)

Follow-up Workflow: Auto-email confirmation + schedule the 8-minute feedback session

Design Note: Keep layout clean and breathable; don't overcrowd the form

Talking Points for Prospective Clients

"Before we design your 8-day intensive, we need to understand where you are. This questionnaire takes 15 minutes and gives us the clarity we need to make your transformation personal and powerful. Everything you share stays confidential. We're not here to judge—only to listen, learn, and design something that actually works for you."