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Within each section, rate the statements on a scale of 1 to 5:

1 = Strongly disagree 2 = Disagree 3 = Neutral

4 = Agree 5 = Strongly agree


Finding meaningful connections that allow you to view life with a deeper significance, such as your identity, values, sense of purpose, or something greater than yourself.

Spirituality - Select one answer


Self-expression – drawing, cooking, playing an instrument are examples of creative expression. However, it’s more than artistic output. It can be the ability to make connections between existing ideas or come up with new solutions to a problem.

Creativity - Select one answer


Understanding and being in control of your finances can lead to feelings of freedom, comfort, and confidence, which can improve health in many ways.

Finances - Select one answer


It’s important to find fulfillment at work. Having a career and purpose that nourishes you and compensates you fairly can affect satisfaction, work life balance, and overall well-being.

Career - Select one answer


Learning is important to health and life satisfaction at all stages of life. Education can mean going back to school, engaging in self-study, or staying curious through various experiences to continually grow.

Education - Select one answer


Taking care of all the components of your health. Our bodies, minds, spirits all have needs and meeting those unique needs can improve our overall health, happiness, and ability to feel satisfied.

Health - Select one answer

Physical Activity

Your body thrives on movement. Finding types of movement that nourish your body, mind, spirit can provide a sense of balance.

Physical Activity - Select one answer

Home Cooking

Taking care of yourself by nourishing your physical body feeds you mentally, spiritually, and emotionally. Sharing food can be both an act of self-care and an expression of love for others.

Home Cooking - Select one answer

Home Environment

This includes physical living space, the people in your home, your neighborhood, and natural surroundings. On a larger scale, it also includes the city, state, and country you live in. It includes everything that surrounds you throughout the day and has the potential to either energize you or drain you.

Home Environment - Select one answer


Your connection to other human beings greatly contributes to your health. Your relationships with those closest to you can provide important forms of support, connection, and love that can nourish you deeply.

Relationships - Select one answer

Social Life

Creating space for social interactions with others is important to your health, happiness, and wellbeing. It can be engaging in activities to build new connections, maintaining existing friendships, chatting with someone you don’t know, or building a sense of belonging in a community.

Social Life - Select one answer


It is the experience of positive emotion recognizable through physical expression, such as laughter, smile, sense of light in the body. It can come from an external source, such as a child or baby smiling at you, or by connecting with something in alignment with yourself or values.

Joy - Select one answer

*Right click and select print before submitting to keep for your record*

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