Use this "Wellness Index Assessment" to get insights into where you have the lowest score.
Take the following wellness index to. Subtract the sub-totals to get Total: you can have a negative number. Use 0-5 as your range with 5 being perfect match and 0 = to not at all.
Nutrition Survey:
1. _____ I drink 6-8 glasses of water/day.
2. _____ I take nutritional supplements that include vitamins, minerals and anti-oxidants.
3. _____ I am working with a nutritionist, a dietician or I belong to a weight- management group.
4. _____ I consider my diet healthy, AND I regularly read articles on nutrition research.
5. _____ At least three times week I eat food prepared from scratch.
Subtotal: _______
6. _____ I rarely plan meals in advance, and I cook what is at hand.
7. _____ I have two or more alcohol drinks per day.
8. _____ I often feel uncomfortable after eating. (e.g. bloating, stomach pain, tired, heartburn, or gas)
9. _____ I eat fast food 4 times/week or more.
10. _____ I smoke regularly.
Subtotal ________
Total : ________________
Stress Management Survey:
1. _____ I meditate 4 or more times/week.
2. _____ I regularly use breathing and/or relaxation exercises.
3. _____ I spend a lot of time with my pet(s).
4. _____ I feel it is important to take frequent breaks throughout the day.
5. _____ I have a large circle of friends.
Subtotal: _______
6. _____ I feel tired all the time.
7. _____ Deadlines or test cause me extreme anxiety.
8. _____ I usually get less than 7 hours of sleep/night.
9. _____ I drink more than 2 cups of coffee/day.
10. _____ I often feel angry.
Subtotal _______
Total ______
Activity Survey:
1 _____ I regularly participate in recreational activites.
2. _____ I thrive under pressure and competetion.
3. _____ I have worked with or I am working with a personal trainer.
4. _____ I am participating in some kind of mind/body practice.
5 _____ I exercise 3 times week or more.
Subtotal _______
6. _____ I do not like to exercise.
7. _____ I only have time to exercise or play sports on the weekend.
8. _____ I feel the current perspective on regular exercise is over exaggerated.
9. _____ Exercise is uncomfortable and/or painful for me.
10. _____ I feel working with a personal trainer is not necessary
sub total _______
Total___________
Spiritual Assessment:
1. _______I consider myself to be spiritual aware.
2. _______I attend or practice a spiritual service every day.
3. _______I consider spiritual completely different than religious.
4. _______I find solace in my spiritual practice.
5. _______When I don’t do my spiritual practice, I have less patience.
Subtotal_______
Spiritual Assessment:
1. _______ I think there is nothing after death.
2. _______ People who need faith are weak.
3. _______ I find spiritual practices silly.
4. _______ I think faith is a crutch.
5. _______ There is no God.
Subtotal_______
Total___________
Graph your totals here:
+25 ____________________________
+20 ____________________________
+15___________________________
+10______________________________
+5______________________________
0___N ___St_____A______Sp______
- 5 _____________________________
-10______________________________
-15_______________________________
- 20_______________________________
-25______________________________