How old are you?



BODY — Nourishing the Physical

1. I check in throughout the day to see how my body feels.

2. I experience tightness, tension or pain regularly in my back, hips or knees.

3. I experience tightness, tension or pain regularly in my upper shoulders or neck.

4. I feel strong in my body and confident lifting heavier objects.

5. Which of the following is most true?

6. When I sit for long periods of time, I remember to get up for movement breaks.

7. On average, I exercise ___ times per week.



ENERGY — Feeling Vitality

1. Most days, I feel enthusiastic, energetic and fully charged.

2. I describe my daily energy level as:

3. I describe my current sleep habit as:

4. During my daily activities:

5. I would best describe my normal lunch habit as:

6. I often experience digestive issues.

7. When I experience stress:



MIND — Sustaining Attention

1. In my day-to-day life:

2. I am able to concentrate on just one thing for stretches of time – whether at work or at home.

3. When I’m given a project at work:

4. In a high-stressed or pressured situation, I am usually able to keep calm and mentally clear.

5. I have a formal meditation practice.

6. When I have conversations with my loved ones...

7. I seek out activities that will systematically build my mental capacity.



BEHAVIOR — Shaping Attitudes and Character

1. When it comes to my feelings and moods:

2. I feel like I can manage my moods and behaviors for the benefit of my work and my relationships.

3. When I feel I need to unwind, I...

4. I do a good job of separating my work time and my down time. I leave myself unscheduled time to reflect or rest.

5. I have practices/habits/rituals in place to help me unplug from work/family life.

6. I think of my behaviors as something I can change.



SPIRITUALITY — Finding Purpose and Fulfillment

1. I can see a clear path ahead to my goals in life and/or work.

2. I feel I have an ability to state my truth in life.

3. I have consciously defined and prioritized my values.

4. I regularly cultivate opportunities to connect with my creativity.

5. I would best describe my morning routine as:

6. I would best describe my bedtime ritual or routine as:

7. I feel a connection with a spiritual purpose or source.


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