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Wellness Quiz

PHYSICAL WELLNESS
How would you rate your:
1. Energy level?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
2. Level of alertness throughout the day?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
3. Resilience to colds, flus and allergies?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
4. Overall digestion?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
5. Food cravings & dietary choices?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
6. Capacity to exercise?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
7. Physical health overall?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
8. How frequently do you have headaches, muscle, joint aches or pains?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
9. How difficult is it to manage any physical challenges you already have?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
10. Is it easy to fall asleep and stay asleep throughout the night?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
11. How often do you sleep7-8 hours at night?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
12. How regularly do you wake up in the morning feeling refreshed?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
EMOTIONAL WELLNESS
How would your rate your:
13. Social relationships?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
14. Ability to manage conflict?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
15. Quality of communication with others?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
16. Ability to work well with others?*
- Poor
- Fluctuating
- Fair
- Good
- Excellent
17. Self esteem, self acceptance?*
- Poor
- Rarely
- Sometimes
- Mostly
- Always
18. Overall emotional health?*
- Poor
- Rarely
- Sometimes
- Mostly
- Always
How frequently do you have difficulties with:
19. Depression?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
20. Anxiety?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
Difficulties with fears?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
21. Negativity?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
22. Stress?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
23. Focus and concentration?*
- Never
- Rarely
- Sometimes
- Mostly
- Always
OCCUPATIONAL WELLNESS
How would you rate your:
24. My work atmosphere supports health and wellness*
- Never
- Rarely
- Sometimes
- Mostly
- Always
25. The intensity of my work is in balance with my abilities*
- Never
- Rarely
- Sometimes
- Mostly
- Always
26. Interpersonal communications are positively facilitated*
- Never
- Rarely
- Sometimes
- Mostly
- Always
27. Communication with management is positive and open*
- Never
- Rarely
- Sometimes
- Mostly
- Always
28. I am recognized for my contributions*
- Never
- Rarely
- Sometimes
- Mostly
- Always
29. Teamwork and collaboration is facilitated where appropriate*
- Never
- Rarely
- Sometimes
- Mostly
- Always
30. I feel a sense of community and belonging*
- Never
- Rarely
- Sometimes
- Mostly
- Always
31. My work offers me a sense of purpose and fulfillment*
- Never
- Rarely
- Sometimes
- Mostly
- Always
SPIRITUAL WELLNESS
How would you rate your:
33. I feel a sense of calmness in the midst of activity*
- Never
- Rarely
- Sometimes
- Mostly
- Always
34. I experience an inner source of joy independent from outer events*
- Never
- Rarely
- Sometimes
- Mostly
- Always
35. I can relax into an inner haven of peace*
- Never
- Rarely
- Sometimes
- Mostly
- Always
36. I am strong in myself and follow through on my intentions*
- Never
- Rarely
- Sometimes
- Mostly
- Always
Get Your Results
Enter your information below. Your results will be displayed on the next screen and also emailed to you.
Name*
First Last
Email*
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Comments
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