1. Sleep

How many hours of quality sleep do you typically get each night?

• 1 pt Less than 5 hours
• 2 pts 5-6 hours
• 3 pts 6-7 hours
• 4 pts 7-9 hours

2. Sleep

How rested do you feel when you wake up in the morning?

• 1 pt Exhausted
• 2 pts Somewhat tired
• 3 pts Fairly rested
• 4 pts Fully refreshed

3. Nutrition

How often do you eat balanced, nutritious meals?

• 1 pt Rarely
• 2 pts Sometimes
• 3 pts Most days
• 4 pts Every day

4. Nutrition

How well do you stay hydrated throughout the day?

• 1 pt I rarely drink water
• 2 pts I drink a little
• 3 pts I drink enough most days
• 4 pts I am consistently well-hydrated

5. Exercise

How often do you engage in physical activity or movement?

• 1 pt Almost never
• 2 pts 1-2 times a week
• 3 pts 3-4 times a week
• 4 pts 5+ times a week

6. Exercise

How energized do you feel in your body day to day?

• 1 pt Constantly fatigued
• 2 pts Often sluggish
• 3 pts Generally energized
• 4 pts Vibrant and strong

7. Stress

How well do you manage stress in your daily life?

• 1 pt I feel overwhelmed often
• 2 pts I struggle but cope
• 3 pts I manage it fairly well
• 4 pts I handle stress with ease

8. Stress

Do you have healthy outlets for stress such as journaling, deep breathing, or talking to someone?

• 1 pt Not really
• 2 pts Occasionally
• 3 pts I have some outlets
• 4 pts Yes, consistently

9. Spirituality

How often do you engage in spiritual practices such as prayer, meditation, worship, or reflection?

• 1 pt Rarely or never
• 2 pts Occasionally
• 3 pts Several times a week
• 4 pts Daily

10. Spirituality

How connected do you feel to your sense of purpose and inner peace?

• 1 pt Very disconnected
• 2 pts Somewhat disconnected
• 3 pts Mostly connected
• 4 pts Deeply connected