Valued living questionniare
Below are areas of life that are valued by some people. We are concerned with your quality of life in each of these areas. One aspect of quality of life involves the importance one puts on different areas of living.

Rate the importance of each area (by choosing a number) on a scale of 1-10. 1 means that area is not at all important. 10 means that area is very important. Not everyone will value all of these areas, or value all areas the same.

Rate each area according to your own personal sense of what is important to you.

1st name and intial
e.g Chris S
Your answer
1=not at all important, 10=extremely important
1
2
3
4
5
6
7
8
9
10
1. Family (other than marriage or parenting)
2. Marriage / couples / intimate relations
3. Parenting
4. Friends/social life
5. Work
6. Education / training
7. Recreation/fun
8. Spirituality
9. Citizenship / Community Life
10. Physical self care  (diet, exercise, sleep)
How consistent have you been with living your values?
In this section, we would like you to give a rating of how consistent your actions have been with each of your values. We are not asking about your ideal in each area. We are also not asking what others think of you.

Everyone does better in some areas than others. People also do better at some times than at others. We want to know how you think you have been doing during the past week.

Rate each area (by choosing a number) on a scale of 1-10.
1 means that your actions have been completely inconsistent with your value.
10 means that your actions have been completely consistent with your value.

1=totally inconsistent with your values, 10=completely consistent with your values
1
2
3
4
5
6
7
8
9
10
1. Family (other than marriage or parenting)
2. Marriage / couples / intimate relations
3. Parenting
4. Friends / social life
5. Work
6. Education / training
7. Recreation/fun
8. Spirituality
9. Citizenship / Community Life
10. Physical self care  (diet, exercise, sleep)
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