wellness survey

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Name
Email
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Physical wellness includes your knowledge, motivation and commitment to fitness and physical health goals. These goals are very different for each of us and include movement, healthy eating, and avoidance/ moderation of substances that lower your vitality. Physical wellness includes our responsibility to be aware when we are not feeling well and taking proper action to help our body’s return to wellness.

I recognize the stressors in my life and know how to manage stress in healthy ways.

I eat healthy, nutritious meals on a regular schedule.

I sleep well and wake up feeling rested and alert.

I make time to move, to be active, including periods of vigorous exercise as suits my ability.

I avoid harmful behaviors and substances including avoidance of smoking, drugs and moderation of alcohol.

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Social and cultural wellness calls us to be willing to contribute to others. Social and cultural wellness allows you to have positive interactions with others, even those who might differ from your personal cultural or social circles. This aspect calls us to make time for leisure, recreation, friendships and intimate connections. In building social and cultural wellness, we learn to communicate- to share and to listen with care.

I am interested and make time for friends and my community.

I am able to build and maintain healthy relationships with friends and loved ones.

I feel that I am a part of a group or community.

I can express myself in an honest and appropriate way that is respectful of others and their differences.

I can be relied on to fulfill social roles in family, friends and community.

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Emotional wellness looks at how you feel about yourself and your life. Emotionally well people can face life’s stressors without feeling controlled by the stress. Good emotional health considers mental health, positivity, good self esteem and a positive self-image.

I am aware of and accept my feelings as separate from my actions.

I make time for reflection, meditation and self-improvement.

I ask for help when I need it.

I love and accept myself as a unique and wonderful human being.

I recognize the stressors in my life and know how to manage stress in healthy ways.

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Financial wellness isn't always included in discussions of wellness as they are something outside of the person but can be an powerful source of conflict and frustration to some.  Financial wellness is having a clear picture of your financial situation and managing it to meet your goals. As in all aspects of wellness, we seek to find a balance and comfort in regard to our financial dealings.

I have enough money to meet my living requirements.

I have short and long term financial goals.

I live within my means

I use a budget to manage my spending.

I have the knowledge of how to best live on my income.

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Career wellness challenges us to find work that we find enjoyable and rewarding. This includes doing work that we feel is valuable to the well-being of our community and our world. For those who don’t feel their career path is rewarding and can’t make a change right now, we ponder how we might get training to make the change in the future or find volunteer opportunities outside of work to bring us the satisfaction lacking in our present career.

I am satisfied with my career and my role as a contributing member of my community.

I seek new challenges and opportunities for learning and personal development.

I value attaining new skills and knowledge and am willing to share knowledge with others.

I know how to find resources to give and receive new knowledge and experience.

I see myself as being a productive and valuable part of the world.

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Environmental wellness involves a knowledge of the inter-dependency of all lifeand how living with environmental awareness as to how our choices can benefit or destroy the environment. Environmentally well people choose foods, cleaning chemicals, packaging, lawn care, transportation, recycling and more with concern as to doing the least environmental damage.

I am aware of my relationship to the environment and make choices to protect it.

I make positive contributions to the health and safety of my community.

My personal environment is safe and nurturing to me and those who share space with me.

I make decisions with an awareness of how my choices affect others.

I believe each of us must play a part in protecting our world.

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Spiritual wellness takes a look at how we experience meaning and purpose in life. True wellness in this regard involves turning to our inner selves, our deep belief and inner wisdom not just doing what others tell us to do in our spiritual life. Spiritual wellness involves living with compassion and peace and living a life that is true to your goals and values.

I feel an overall sense of peace and well-being in my life

I engage in spiritual or religious practices that promote my spiritual well-being.

I believe my life to have direction and meaning

I understand my own values and beliefs, and respect the values, ethics and beliefs of others

I experience love, joy, peace and fulfillment in my life