What's Your Wellness Score?
How many hours of sleep do you typically get each night?
4-6 hours
6-8 hours
Less than 4
How often do you experience mental stress or anxiety?
Rarely
Occasionally
Often
How often do you engage in activities where you feel happiness and contentment?
Daily
Weekly
Monthly
Sporadically
How connected do you feel to your friends and family? On a scale of 1-10 with 10 being the most connected.
1
2
3
4
5
6
7
8
9
10
Do you find your work meaningful and fulfilling?
Yes, I do
Barely
Never
Sometimes
How satisfied are you with your current financial situation? On a scale of 1-10 with 10 being most comfortable.
1
2
3
4
5
6
7
8
9
10
In what ways do you take care of the environment? (Check all that apply)
Decluttering personal space
It hasn't crossed my mind
Reducing, Reusing and Recycling
Volunteering for public Clean Ups
Check any of these that apply to you
I believe that life is meaningless
I believe my life has meaning and purpose
I feel connected to spiritual and religious beliefs
I have no connection to a higher power
How is your relationship with alcohol or caffeine?
I drink them often (weekly)
I rarely partake (from time to time)
I drink them occasionally (monthly)
How often do you engage in regular physical activity or exercise?
Weekly (Scheduled)
Monthly (Intentional)
Rarely (Unscheduled/Unintentional)
Do you practice any form of mindfulness or meditation ?
I've been meaning to learn more about it
Yes, definitely. It's the only way I stay sane
No, never heard anything about it
Sometimes if I have time or when I really need it
How do you cope difficult emotions? (Check all that apply)
I avoid thinking about them
I allow myself to feel & reach out to a loved one for support.
I sit with them and channel the energy into something productive
I journal and release the emotion
If conflict arises in your relationships, how do you maintain healthy boundaries?
I express my needs in a strong but reasonable way
I grow distant and retreat when I feel uncomfortable instead of speaking up
I relinquish how I feel and put other's needs first
I do my best to explain how I feel and find middle ground
Yes, I'm very focused on building my career
I do not dream of labor!
Doing my best to pay the bills
How satisfied are you with your living environment?
1
2
3
4
5
6
7
8
9
10
How often do you reflect on your values and personal growth?
I make yearly goals and do my best to stick with them
I go wherever the wind takes me
I am on track with my long term goals
I don't really think about values or personal growth
Do you practice safe and responsible sexual behavior?
Raw is law
I get screened for HIV with a new sexual partner
I practice abstinence/celibacy
I regularly use condoms/ birth control
How would you describe your diet? (Check all that apply)
Balanced (Equal part fruits, vegetables and junk food)
Personally, I think it can be improved
The food I eat makes me feel good to be in my body
Food is medicine
I would like to eat out less
Do you engage in activities that nurture your spiritual well-being?
Yes
No
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