Assessment | MON ZÉNITH

1. General Information

Name, surname and title of the person responsible for monitoring

Name / Surname

Age

Date of birth

Occupation / Main Profession

Name, surname and position of the person in charge of the collection

Gender / Identity

Women

Man

Other

Family situation

Bachelor

Married / Common-law partner

Divorced / Single parent

Blended family

Working hours

Regular office hours (9am-5pm)

Shift work

Night shift / Rotation

Self-employment / Atypical hours

Children in your care

Yes

No

Accuracy of hours / Number of hours per week

2. Health history

Direct family history

Father

Mother

Siblings

Personal profile

Diagnosed pathologies

Medication & Supplements

Recent surgery(ies)

3. Assessment of lifestyle habits

Pillar 1 – Physical Activity
General level of activity

Zone 2 Training

Muscle strengthening

Functional limitations

Joint pain

Chronic fatigue

Cardiac / Respiratory

Other

General level of activity

Sedentary

Light

Moderate

Athletic

Spontaneous activity

Pillar 2 — Food

Heure du déjeuner

Heure du dîner

Dernier repas

Heure du souper

Transit

Normal

Slow motion

Pillar 3 – Mental Load

Stress level

Weak

Moderate

Pupil

Intensity of mental work

Weak

Moderate

Pupil

Cognitive fatigue

Yes

No

Pillar 4 — Sleep

Heure du coucher

Heure du lever

Average duration

Pillar 5 — Environment

Smoking

Yes

No

Air quality

Good

Average

Weak

Level of clutter

Weak

AVERAGE

Pupil

Access to nature

Easy

AVERAGE

4. Current monitoring devices

Smartwatch / Smart Ring

Yes

No

Parameters tracked

My Zenith Logbook

Yes

No

5. Summary & Prognosis Score

Clinical Comments & Recommendations

Overall Score

1. General Information

2. Health history

Direct family history

Personal profile

3. Assessment of lifestyle habits

Pillar 1 – Physical Activity
General level of activity

Pillar 2 — Food

Pillar 3 – Mental Load

Pillar 4 — Sleep

Pillar 5 — Environment

4. Current monitoring devices

5. Summary & Prognosis Score

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1. General Information

2. Health history

Direct family history

Personal profile

3. Assessment of lifestyle habits

Pillar 1 – Physical Activity General level of activity

Pillar 2 — Food

Pillar 3 – Mental Load

Pillar 4 — Sleep

Pillar 5 — Environment

4. Current monitoring devices

​5. Summary & Prognosis Score

Subscribe to the newsletter

Merci! Vous recevrez notre prochaine infolettre

Pillar 1 – Physical Activity
General level of activity

5. Summary & Prognosis Score