Full Name
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Score each of the life categories on a scale of 1 to 5. How would you rate 'Work & Career'? With 1 being very unsatisified and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Fun & Hobbies'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Romantic Relationships'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Money & Finances'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Connection - Friends & Family'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Health, Fitness & Self-care'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Spirituality & Faith'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How would you rate 'Personal Development & Growth'? With 1 being very unsatisfied and 5 being totally satisfied and happy.
1
2
3
4
5
How well do you sleep at the moment?
Very well - like a log!
Up & Down - sometimes well and sometimes I struggle
I consistently have broken sleep
Not very well at all
How much 'me-time' do you get, to make time and space for yourself?
Lots - it is a priority for me
I try and I know it is important but other things often get in the way
Very little or none at all
How much of the time do you feel tired?
Most of the time, I feel tired constantly
Sometimes, mainly at certian points in the day when I hit a slump
Rarely, I am energised and my energy is well balanced
Do you feel in touch and in rhythm with yourself and your body?
Very much in touch and connected
Sometimes, often life takes over and I ignore myself
Not in touch at all, I don't know what really feels like
What would you say best describes your overall mood?
Happy
Excitable
Hopeful
Indifferent
Anxious
Angry
Sad
