Wellness Wheel Questionnaire

1 = No/Never   2 = Sometimes   3 = Usually   4 = Yes/Always

General Health		1	2	3	4
1.	I am well and do not get sick often.
2.	I have energy and feel good all day.
3.	I have little pain.
4.	I don't take much medicine.
5.	I wake up excited about my day.
Total Score 0/20
Self Respect/Self Love		1	2	3	4
1.	I like myself.
2.	I appreciate my body.
3.	I am usually happy.
4.	I don't dwell on what others think.
5.	I am a good friend and have several friends.
Total Score 0/20
Breathing		1	2	3	4
1.	I do aerobic exercise 3 times a week.
2.	I notice how stress affects my breathing.
3.	I take breaths when I eat.
4.	I take a deep breath when I'm upset.
5.	I spend time outside breathing in nature daily.
Total Score 0/20
Positive Choices		1	2	3	4
1.	I eat 2 vegetables, 2 fruits and 2 grains every day.
2.	I drink water and drink little caffeine.
3.	I find ways to spend time that feel good.
4.	My friends make me feel good.
5.	I watch TV or play video games less than 2 hrs/day.
Total Score 0/20
Balance		1	2	3	4
1.	I know what I do best and do it often.
2.	I take time for myself and rest daily.
3.	I play daily.
4.	I do creative activities often.
5.	I learn & work daily.
Total Score 0/20
Trust		1	2	3	4
1.	I trust that I can use all my experiences to learn.
2.	I do not over-react.
3.	I allow myself to be touched and healed as needed.
4.	I am kind and find kindness is returned back to me.
5.	I know my actions/thoughts affect myself & others.
Total Score 0/20