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Wellness Wheel Form

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Proof that chiropractic improves lives, not just spines!

If you want to see more wellness patients, you’ll want to start measuring wellness.

Begin on the first visit by presenting a copy of the Wellness Wheel.

Patients rate their current well-being on a scale of 1 to 10 in seven areas:

Physical
Financial
Family
Social
Career
Spiritual
Mental

Now you have a baseline measurement to which you can compare the impact of their chiropractic care.

Have them complete a new one as a prelude to their progress exam.

They’ve long forgotten how they completed the original form weeks earlier.

Then, at your progress report, compare their pre- and post-care forms. Identify the improvements and discuss your observations.

Slow recovery? Are there underlying stresses in their life? Is one of the spokes bringing down their overall health?

Without this bigger context, many patients may be inclined to blame you for a lack of progress!

Use the Wellness Wheel to help every patient see how chiropractic care improves spines and lives.

Wellness Wheel Assessment Handout implementation-ideas.gif
8½" X 11"
Pkgs. of 50

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289 Words
6.4 Grade reading level

On a scale of 1 (poor) to 10 (optimum), mark your current health level in these seven essential areas:  

Physical Health

What is your physical condition? Are you receiving good nutrition, drinking plenty of water, getting regular exercise and enjoying the proper weight for your height?

Financial Health

Are you living within your means? Is your debt within manageable limits? Do you make charitable contributions and save for the future? Are you properly insured?

Family Health

Are you in a loving relationship with shared values? Do you give your family time and attention? Do you have a close connection with children, parents and relatives?

Social Health

How well do you interact with others? Are you able to maintain long-term friendships? Are you comfortable in new social situations and the company of others?

Career Health

Do you like what you do for a living? Does your career reflect and advance your deepest values? Is your work meaningful and suited to your skills and interests?

Spiritual Health

How connected do you feel to the higher power in your life? Do you enjoy a sense of purpose and peace? Do your regularly study, meditate, pray or worship?

Mental Health

Are you open to new ideas? Do you seek out new experiences and learn new skills? What is the quality of the information and entertainment you allow into your mind?

Mental health

Are you open to new ideas? Do you to seek out new experiences and learn new skills? What is the quality of the information and entertainment you allow into your mind?


Your health affects everything you do and everyone you know. We use this confidential worksheet to record a "snapshot" of your estimated overall health so we can track your progress.

© 2003 Patient Media, Inc.