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Life Evaluation
Download the personal history form
Challenge
yourself and honestly and openly evaluate
your feelings relative to the quality of YOUR LIFE.
1
= unhappy 2 = mostly dissatisfied 3 = mixed
4 = mostly satisfied 5 = very happy
| 1. Physical well-being. | 1 2 3 4 5 |
| 2. Spiritual well-being. | 1 2 3 4 5 |
| 3. The actual work you do. | 1 2 3 4 5 |
| 4. Mental/Emotional well-being. | 1 2 3 4 5 |
| 5. Difficulty falling or staying asleep. | 1 2 3 4 5 |
| 6. Incidence of fatigue and low energy. | 1 2 3 4 5 |
| 7. Experience of vague fears or anxiety. | 1 2 3 4 5 |
| 8. Experience of depression or lack of interest. | 1 2 3 4 5 |
| 9. Incidence of feelings of joy and/or happiness. | 1 2 3 4 5 |
| 10. Being fidgety or restless, difficulty sitting still. | 1 2 3 4 5 |
| 11. Difficulty thinking or concentrating, indecisiveness. | 1 2 3 4 5 |
| 12. Openness to guidance by your "inner voice/feelings". | 1 2 3 4 5 |
| 13. Interest in maintaining a healthy lifestyle (diet, fitness..). | 1 2 3 4 5 |
| 14. Feelings of tension/stiffness/lack of flexibility in your spine. | 1 2 3 4 5 |
| 15. The extent to which you can adjust to changes in your life. | 1 2 3 4 5 |
| If you have not responded with "5" in all the above categories you are not getting all you deserve out of life. We can help you get re-connected to your Inner Wisdom and increase your quality of life. | |