Wellness Questionnaire for ECE Professionals

Name *

Email *

Address *

Phone number *

What aspects of your life bring you the greatest joy? *

What contributes most to your physical stress, strain, pain? *

What contributes most to your mental/emotional stress? *

Do you have a routine self-care regimen? If so, please describe. *

On a scale of 1-10, with 10 being the most ideal, how would you rate your overall quality of life? *

1

2

3

4

5

6

7

8

9

10

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