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Analyze Your Wellness

Wellness Wheel Fillable for Clients_Whit

Respond to the questions below (if using cell phone, you can view the the questions by clicking on the pdf below). Once you have your scores, send them to the Wellness Studio using the form below, and you'll receive an email with your graphed results within a day or two.

Survey Instructions: The Wellness Integrated Life model is a useful way to examine and visualize your holistic health, and to aid you in setting personalized goals that are meaningful and motivating. Complete all of the questions below, jotting down your total scores for each section as you go. Each "yes" response is scored as 1 point, while "no" responses are scored as 0. When you reach the end of the survey, enter your five total scores into the form and the Wellness Studio will email you a personalized, graphed Wellness Wheel via email.

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Note: It is important to be very honest with yourself when answering these questions.

Only you and your coach will see your scores, which will help you to better understand your holistic wellness and inform your goals throughout the coaching process.

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  • I intentionally stretch and move my body throughout the day to increase my energy level. 

  • I set weekly physical exercise goals and strive to meet them.

  • I am aware of my nutritional needs and eat healthy foods at most meals.

  • I maintain a healthy body weight, and feel comfortable with my body.

  • I sleep at least seven hours most nights and feel rested throughout the day.

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Total Score:  ___ points (0-5 Range)

Graph your total score on the Physical portion of the Wellness Wheel above.

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  • I prioritize and nurture healthy and meaningful relationships with others.

  • I ask for support from others when needed, and listen intently when needed. 

  • I actively work through conflicts to ensure my relationships grow and stay strong.

  • I belong to a group(s) and/or socialize with people who share similar interests.

  • I have multiple people in my life who bring me joy and fulfillment.

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Total Score:  ___ points (0-5 Range)

Graph your total score on the Social Connection portion of the Wellness Wheel above.

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  • I feel mentally engaged in my work, both inside and/or outside of the home. 

  • I enjoy seeking out informal and/or formal educational opportunities that challenge me.

  • It is important to me to exercise my brain to sustain my mental sharpness (e.g., reading books, doing puzzles, listening to podcasts).

  • I build downtime into my week in order to rest my mind and to recharge. 

  • I consider myself to be a curious person who enjoys engaging in stimulating discussions with others.

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Total Score:  ___ points (0-5 Range)

Graph your total score on the Intellectual portion of the Wellness Wheel above.

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  • When I'm faced with a challenging situation, I acknowledge that it is hard, while also thinking about how I can grow from the experience (i.e., "a growth mindset").

  • I try to "go with the flow" and stay adaptable throughout the day.

  • I notice and embrace my daily emotions, both positive and negative.

  • I am aware of how my thoughts and the stories I tell myself impact my perceptions and my mood.

  • I actively engage in practices that help me to manage my emotions and stress levels throughout the day.

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Total Score:  ___ points (0-5 Range)

Graph your total score on the Emotional portion of the Wellness Wheel above.

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Meaning and Purpose.png

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  • I take time to think about the values and beliefs that are most important to me.

  • I am actively engaged in activities that I find personally meaningful and gratifying.

  • I practice self-acceptance, striving to feel comfortable with who I am. 

  • I prioritize the many obligations in my life, and give the most energy to what's most important to me.

  • My goals are intentionally and directly linked to my values, and are therefore highly motivating for me.

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Total Score:  ___ points (0-5 Range)

Graph your total score on the Meaning & Purpose portion of the Wellness Wheel above.

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In the form below, enter your total score for each of the five wellness categories. The Wellness Studio will email you a personalized, graphed Wellness Wheel via email within 24 hours.

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My Wellness Wheel Scores

Please send me my completed Wellness Wheel Graph!

Source: Questions Adapted from SAMHSA's "Creating a Healthier Life"

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