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Wellness Self-Check
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* Indicates required question
Name
Your answer
Email
*
Your answer
I check in with my emotions daily.
*
never
1
2
3
4
5
always
I read something other than social media posts daily.
*
never
1
2
3
4
5
always
I drink at least 60 ounces of water daily.
*
never
1
2
3
4
5
always
My home brings me peace.
*
never
1
2
3
4
5
always
I am happy with the amount of money I make.
*
never
1
2
3
4
5
always
I have a support system.
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never
1
2
3
4
5
always
I have my own wellness affirmations that I say out loud with emotional intensity daily.
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never
1
2
3
4
5
always
I find a balance between work and leisure time.
*
never
1
2
3
4
5
always
I take care of my home.
*
never
1
2
3
4
5
always
I tithe, donate and/or invest regularly.
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never
1
2
3
4
5
always
I like to share my knowledge with others, I teach or write.
*
never
1
2
3
4
5
always
Spirituality helps me feel grateful for the things and opportunities I have.
*
never
1
2
3
4
5
always
I balance my own needs with the needs of others.
*
never
1
2
3
4
5
always
I feel connected to my culture.
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never
1
2
3
4
5
always
I develop and cultivate feelings of love for myself.
*
never
1
2
3
4
5
always
I feel good in my body.
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never
1
2
3
4
5
always
I start each day by stretching.
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never
1
2
3
4
5
always
I sleep 7-8 hours every day.
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never
1
2
3
4
5
always
I pray and/or meditate daily.
*
never
1
2
3
4
5
always
I earn money in ways that are consistent with my values, my mentality and with the work that inspires me.
*
never
1
2
3
4
5
always
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