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Dr. Olpin will personally and confidentially receive your answers to the questions below. Once he has reviewed your answers he will reply to you via email, and let you know the areas he sees that you could be working on to improve your health and life.

There is NO commitment from taking this survey, it is only to allow Dr. Olpin a snapshot into your current state to help identify areas he feels could create more balance in your life, with or without working together.

You have nothing to lose, and will receive valuable feedback based off the answers you submit.
Resting Heart Rate
After you have been sitting or relaxing for a period of time, find your pulse.

Your radial pulse can be found on the thumb side of your wrist. Your carotid pulse can be found on your neck, just under the jaw.

Count the number of beats for sixty seconds.

Record your heart rate in beats per minute (BPM) here:
Breathing Pattern
Sit in a chair so your back is primarily straight up and down against the backrest.

Place one hand on your abdomen with your palm covering your navel. Place the other hand on your chest.

While sitting straight up, notice your breath as it goes in and comes back out.

Notice which hand moves more—your chest or your abdominal hand.
Respiration Rate
While sitting, breathe normally and naturally.

Count how many natural, effortless breaths you take in a minute. This is called respiration rate.

Each inhalation and exhalation cycle is considered one breath.
Think back over the last month of your life, including all of your waking moments.

Give yourself a rating on the “Stress-O-Meter” along a continuum in which:

“1” means that you feel your life has been relatively stress-free during that period. You have felt blissful and calm most of the time. Everything seemed to go your way.

“10” means that you felt very high anxiety most of the time and that this was a month packed with high levels of stress. You felt totally overwhelmed, like your life was out of control, and like you were unable to cope.

Considering the last month as a single period of time, you most likely would rank yourself somewhere between these two extremes. To average out the month (we all have highs and lows), what number between 1 and 10 would you give yourself?
What do you feel are your three biggest "stress triggers" (things that stress you out)?
Are you willing to put in a little work to reduce your stress?
What’s the best email address for Dr. Olpin to send you his thoughts on your current level of health and wellness? 
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