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Comprehensive Wellness Assessment
Personal Info
Full Name
Email Address
Physical Health (1 = Low, 7 = High)
How healthy do you feel physically?
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How is your energy level?
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How much pain have you been experiencing in the past week?
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How well have your medications been helping?
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How well have you been sleeping?
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How has your appetite been over the past week?
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How has your appetite been over the past week?
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Emotional Health
How curious have you felt in the past week?
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How caring have you felt?
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How fearful or anxious have you felt over the past week?
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How angry have you felt?
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How playful have you felt in the past week?
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How sad have you felt in the past week?
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Rate your ability to bounce back from difficulties over the past week. *
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Mental Health
How stressful has the past week been?
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How well have you been able to communicate your thoughts?
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How well have you been able to solve problems?
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Rate your ability to remember important things over the past week.
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How well have you been able to focus without getting distracted?
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How creative have you been in the past week?
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How much have you been pursuing your goals?
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Social Health
How safe do you feel with your family?
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How able are you to work with others?
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How confident are you with others?
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How much do you belong with others?
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How safe do you feel with your best friend or your partner?
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How much do you have fun with friends?
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How secure do you feel when you are alone?
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Ecological Health
How much do you notice the beauty in nature?
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How connected with nature do you feel?
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How much do you enjoy relating to plants or animals?
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How much do you worry about climate change?
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How much have you been impacted by natural disasters?
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How much do you try to reduce harm to the environment?
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How satisfied are you with recycling and reusing as ways to reduce environmental damage?
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Spiritual Health
How often do you get so immersed in what you're doing that you lose track of time?
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How helpful is a spiritual practice to you?
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How strong is your connection with god or higher power?
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How balanced, harmonious, or resonant do you feel with the many dimensions of life?
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How strong is your sense of purpose in life?
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Have you ever been through a period where you thought a lot about death?
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Do you believe in a spiritual life after physical death?
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Analyze My Dimensions
Results
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