Wellness Assessment
Please take a moment to answer the following questions.
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1) How physically strong do you feel right now? *
Not At All
Very
2) How mentally clear are you right now? *
Not At All
Very
3) How emotionally stable are you right now? *
Not At All
Very
4) How satisfied with your family relationships? *
Not At All
Very
5) How satisfied are you with your intimate relationships? *
Not At All
Very
6) How connected do you feel you are to your community? *
Not At All
Very
7) How satisfied are you with your nutrition? *
Not At All
Very
8) How satisfied are you with your level of exercise? *
Not At All
Very
9) How satisfied are you with your spiritual path? *
Not At All
Very
10) How connected do you feel you are with your friendships? *
Not At All
Very
I agree to be contacted by Debbie Scallion about the results of this assessment
If I answered yes above, here is my email address:
If I answered yes above, here is my phone #:
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