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New Client Intake Form

Occupation / Daily Activity

PEMs Wellness Assessment - The PEMs model, which stands for Physical, Emotional, Mental, and Spiritual, serves as a comprehensive framework for understanding holistic health and well-being. How would you rate your level of wellness in these areas, where 1=low level, 5=high level.

Physical Wellness
1
2
3
4
5
Emotional Happiness
1
2
3
4
5
Mental Outlook
1
2
3
4
5
Spiritual Wellness
1
2
3
4
5
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