Well-being Check-up
Respond to the following based on your experience over the last week.
Good Food *
On a scale of 0 to 5, with 5 being the best, rate yourself on the quality of your relationship to food.
Poor Nutritional Health
Excellent Nutritional Health
Good Sleep *
On a scale of 0 to 5, with 5 being the best, rate yourself on the quality of your relationship to sleep.
Poor Sleep
Excellent Sleep
Good Exercise *
On a scale of 0 to 5, with 5 being the best, rate yourself on the quality of your relationship to exercise.
Poor Exercise
Excellent Exercise
Good Friends *
On a scale of 0 to 5, with 5 being the best, rate yourself on the quality of your relationships with friends.
Limited Connection to Friends
Excellent Connection with Friends
Purpose *
On a scale of 0 to 5, with 5 being the best, rate yourself on the quality of your connection to purpose.
Low Connection to Purpose
Excellent Connection to Purpose
Name *
Your answer
Date *
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