Wellness Satisfaction Survey

Our perception of our health reflects our opinions about our physical, mental, emotional social and spiritual status. Please take some time to carefully evaluate your personal satisfaction with these areas of your health.

Use the following rating system to determine your satisfaction score in each category:
0-Extremely Unsatisfied, 1-Unsatisfied, 2-Neutral, 3- Satisfied, 4-Extremely Satisfied. 

Physical Satisfaction of my:

Exercise habits
Nutrition
Sleep Patterns
Body weight
Pain
Medical health
Stress level
Addictions

Mental Satisfaction of my:

Ability to concentrate
Memory
Learning opportunities
Decision Making
Reading
Organizational skills
Goal setting
Thought provoking discussions

Emotional Satisfaction of my:

Sense of being loved
Fearful thoughts
Positive versus negative feelings
Anger
Laughter
Personal relationships
Ability to express feelings
Self confidence

Social a Satisfaction of my:

Time spent with others
Sense of belonging to a group
Work environment
Recreational time
Time management
Social support system
Community involvement
Ability to get along with others

Spiritual Satisfaction of my:

Spiritual beliefs
Meditation/ prayer practices
Peace and joy
Time spent helping others
Spiritual friends
Perception of death
Ability to forgive
Purpose in life

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