Physical Health
*
Social Health
*
Emotional Health
*
Spiritual health
Intellectual Health
*
I maintain a healthy weight range.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I do cardiovascular exercise on a regular basis (3-‐5X week)
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I do regular strength training exercises (3-‐4X week)
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I stretch before and after vigorous exercise.
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I feel good about the condition of my body
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I feel rested after I wake up
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
My immune system is strong and I am able to avoid most infectious diseases.
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
My body heals itself quickly when I get sick or injured.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I have enough energy to get through most days without being overly tired.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I listen to my body; when I believe something is wrong, I seek professional advice.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
When I meet people, I feel good about the impression I make on them
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am open, honest, and get along well with other people.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I participate in a wide variety of social activities and enjoy being with people who are different than me.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I try to be a "better person" and work on behaviors that have caused problems in my interactions with others.
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I get along well with the members of my family.
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am a good listener
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am open and accessible to a loving and responsible relationship.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I have someone I can talk to about my private feelings.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I consider the feelings of others and do not act in intentionally hurtful or selfish ways.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I consider how what I say, might be perceived by others before I speak.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I find it easy to laugh about things that happen in my life.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I avoid using alcohol as a means of helping me forget my problems.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I can express my feelings without feeling silly.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
When I am angry, I try to let others know in non-‐confrontational and non-‐hurtful ways.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am a chronic worrier.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I recognize when I am stressed and take steps to relax through exercise, quiet time, or other activities.
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I feel good about myself and believe others like me for who I am.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
When I am upset, I talk to others and actively try to work through my problems.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am flexible and adapt or adjust to change in a positive way.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
My friends regard me as a stable, emotionally well-‐adjusted person.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I believe life is a precious gift that should be nurtured.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I take time to enjoy nature and the beauty around me.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I take time alone to think about what's important in life -‐ who I am, what I value, where I fit in, and where I'm going.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I have belief in the importance of things beyond myself.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I engage in acts of caring and good will without expecting something in return.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I feel sorrow for those who are suffering and try to help them through difficult times.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I feel confident that I have touched the lives of others in a positive way.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I work for peace in my interpersonal relationships, in my community, and in the world at large.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am content with who I am.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I go for the gusto and experience life to the fullest.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I tend to act impulsively without thinking about the consequences
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I learn from my mistakes and try to act differently the next time.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I follow directions or recommended guidelines and act in ways likely to keep others and myself safe.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I consider the alternatives before making decisions.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I am alert and ready to respond to life's challenges in ways that reflect thought and sound judgment.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I tend to let my emotions get the better of me and I act without thinking.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I actively try to learn all I reasonably can about an issue before making decisions.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I manage my time well, rather than time managing me.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
My friends and family trust my judgment.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
I think about my self-‐talk (the things I tell myself) and then examine the real evidence for my perceptions and feelings.
*
1 = Rarely, if ever
2 = Sometimes
3 = Most of the Time
4 = Always
What is your total number for Physical Health (ideal score 40 each)
What is your total number for Social Health (ideal score 40 each)
What is your total number for Emotional Health (ideal score 40 each)
What is your total number for Spiritual Health (ideal score 40 each)
What is your total number for Intellectual Health (ideal score 40 each)
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