Physical Health (1 = Low, 7 = High)

How healthy do you feel physically?

How is your energy level?

How much pain have you been experiencing in the past week?

How well have your medications been helping?

How well have you been sleeping?

How has your appetite been over the past week?

How satisfied are you with your body weight?

Emotional Health

How curious have you felt in the past week?

How caring have you felt?

How fearful or anxious have you felt over the past week?

How angry have you felt?

How playful have you felt in the past week?

How sad have you felt in the past week?

Rate your ability to bounce back from difficulties over the past week. *

Mental Health

How stressful has the past week been?

How well have you been able to communicate your thoughts?

How well have you been able to solve problems?

Rate your ability to remember important things over the past week.

How well have you been able to focus without getting distracted?

How creative have you been in the past week?

How much have you been pursuing your goals?

Social Health

How safe do you feel with your family?

How able are you to work with others?

How confident are you with others?

How much do you belong with others?

How safe do you feel with your best friend or your partner?

How much do you have fun with friends?

How secure do you feel when you are alone?

Ecological Health

How much do you notice the beauty in nature?

How connected with nature do you feel?

How much do you enjoy relating to plants or animals?

How much do you worry about climate change?

How much have you been impacted by natural disasters?

How much do you try to reduce harm to the environment?

How satisfied are you with recycling and reusing as ways to reduce environmental damage?

Spiritual Health

How often do you get so immersed in what you're doing that you lose track of time?

How helpful is a spiritual practice to you?

How strong is your connection with god or higher power?

How balanced, harmonious, or resonant do you feel with the many dimensions of life?

How strong is your sense of purpose in life?

Have you ever been through a period where you thought a lot about death?

Do you believe in a spiritual life after physical death?