Wellness & Life style Assessment

NAME

Date

Age

Gender

Section 1: Self-Responsibility and Love

I recognise that the responsibility for my health lies with me rather than with others

I am an active & self-responsible participant in, not a passive recipient of any health treatments I receive

I am aware of my body and its sensations

I am know the difference between accepting responsibility for it and blaming myself

I use pain and disease as an opportunity to reevaluate my lifestyle, my inner reality and environment

It is okay, for me to sometimes feel out of balance, vulunderable and in need of assistance

I understand that I can choose to improve my wellbeing without the need for crisis

I understand that it is possible to discover wellbeing even in the midst of serious or chronic illness

I accept and forgive myself, rather than berate myself for not being as I or others want me to be

I participate in community affairs and contribute to worthy causes

I acknowledge that my wellbeing is interdependent with my community and planet

I minimize my consumption of the planet's resources

I participate in recycling

I am a non smoker

I have fewer than 3 colds per year

I use environmentally friendly household and personal cleaning products

I choose products that are not tested on animals for toxicity

I notice any significant changes in my physical or emotional health & seek professional help if necessary

I understand that life is a journey of continual learning

Section 2: Breath and Movement

I recognise that my emotional states may restrict my breathing, heart rate & blood pressure

I enjoy exploring new and effective ways of caring for myself through moving my body

I know how to use my breath as a means of centering

I practise some form of mind-body-spirit discipline that integrates movement and body awareness

I engage in aerobic activity such as running, brisk walking for at least 20 minutes at least 1-2 times per week

I experience a natural high or altered state of mind when I exercise

I do some form of strengthening and weight baring exercises at least 1-2 times per week

I do some form of stretching exercises 1-2 times per week

I fall asleep easily

I know that sitting for long periods is bad for my health

I know how to push myself in exercise without injuring myself

I know that exercise is essential to maintain muscle strenth and bone density

I know what my resting heart rate is

I get adequate sleep and awake refreshed

I sleep well, rarely waking up until the morning

I am limber when I awake in the morning

I climb the stairs instead of taking the elevators

I walk or ride to local destinations instead of driving

I am aware that exercise alters brain chemistry with endorphins and I exercise to feel better

I know what my body fat and muscle composition

Section 3: Sensory & Perception

I limit my use of artificial light and use natural lighting as much as possible

Iam aware of the impact of different colours and lighting on my wellbeing

I receive massages regularly to increase my wellbeing

I use my sense of smell as a source of warning as well as healing and pleasure

I use music and other pleasant sounds to increase my relaxation and wellbeing

Where appropriate, I communicate with others through touch, instead of restricting myself to verbal comm

I am aware of my need for touch, as well as the cultural taboos around touch

I enjoy experiencing new textures and sensations with my body

I enjoy receiving compliments, appreciation and recognition from others

I recognize the healing power of touch

I enjoy giving appreciation and recognition to others, and acknowledge the people who acknowledge me

I am aware of influences in my environment beyond what I can sense with the usual five sense

I take time to be along

I am aware of what quarter phase the moon is in today

I sense the emotional states of those around me

I vary my diet to discover new tastes

I notice the beauty that is around me in everyday things and people

I am comfortable looking directly into the eyes of others

Section 4: Eating for Wellness

I know what constituties a nutritious and well balanced diet

I use water as a means of refreshment and rehydration

In addition to eating well I also use a multivitamin

I feel good about my eating habits and avoid using food as a reward, escape or punishment

I can tell the difference between stomach hunger and mounth hungerI only eat when I have stomach hunger

I east slowly and chew my food thoroughly, while eating my meals in a relaxed, nurturing environment

I minimize my intake of highly refined or processed foods, especially fast foods

I buy fresh fruits, vegetables and unprocessed meats as much as possible

I avoid chemical additives in my food

I drink less than 2 cups of coffee or strong black tea per day

I drink less than 1 can of soft drink per day

I am aware of the difference between good and bad fats

I eat sufficient proteins every day

I read the labels of processed foods

I have daily bowel movements

I am aware of the difference between refined and complex carbohydrates

I have fewer than 8 alcoholic drinks per week

I have no need for medications or drugs including prescription items

I tune into my body and am aware of which foods make me feel well or unwell physically and psychologically

I have a well stocked pantry and enjoy cooking

I am at my ideal weight for my height and age

I never binge eat

I have no need for recreational drugs

Section 5: Feeling and Emotional Awareness

I allow myself to experience a full range of emotions in constructive ways

I take time out to become aware of what I am feeling

I respect that other people have different sensitivities and ways of expressing their feelings

I recognize, acknowledge and accept my fears

I am able to express my anger constructively without intimidating others, or by swallowing or storing it up

I am able to say no to people without feeling guilty

I know the difference between a feeling and an emotion

My heart is open to experiencing and expressing joy

I feel okay about crying and allow myself to do so when appropriate

I have at least 2 close friends who I can depend on

able to express my anger constructively without intimidating others, or by swallowing or storing it up

I listen to and consider other people's criticisms of me instead of reacting defensively

I like myself and look forward to the rest of my life

I ask for help when I need it

Iam aware that seeking help with my mental and emotional issues is not a sign of weakness

I understand the importance of grieving after a loss and allow myself to do so

I understand that emotional maturity is not about my age, it is something I have to work towards

I see conflict as a way of creating change and discussion & do not confuse it with violence against self or others

My feelings provide me with information about myself & use them to further my growth and evolution

I am willing to take necessary risks

I am aware of the power of negative feelings upon my health & wellbeing & therefore do not deny them

I accept my own worth, while acknowledging others

Section 6: Thinking, Beliefs and Attitudes

I am aware that my perceptions of the world are coloured by my thoughts, beliefs and attitudes

I monitor my thoughts and attitudes throughout the day to ensure they are self and life affirming

I am aware of how my thoughts, beliefs and attitudes affect my health and wellbeing

I am aware of the connection between my thoughts, emotions and my immune system

I am aware that I have significant choice over the throughts and feelings I allow in my mind

I am satisfied with the quality of my thoughts and attitudes

I am aware of how my thoughts influences my feelings and emotions and visa versa

I am aware that I can have logical thoughts as well as intuitive thoughts and both have value

It is easy for me to pay attention, focus and concentrate when I am required to do so

I am aware that if I want to change I have to change my thoughts, beliefs and attitudes

I know the difference between linear (left brain) thinking and patterned orientated, holistic thinking (right brain)

I am aware when I make judgements wherein I make myself right and others wrong

I approach life with the attitude that no problem is too big to confront

I am comfortable that some mysteries aren't meant to be solved

I am able to utilize my intuition, dreams and creativity to gain new insights to change the way I am

I have creative methods for solving problems

I am aware that different people have different thinking styles and all are valuable

Section 7: Work and Play

I take time to nurture and strengthen myself physically, mentally, emotionally and spiritually everyday

I approach challenging tasks from a playful point of view

I enjoy and take time for spontaneous activities

I make an effort to play and work co-operatively, rather than competatively

I am able to lighten up and avoid undue seriousness

I laugh freely and often

I am aware of the importance of laughter and play

I avoid taking on unnecessary and unrealistic burdens and responsibilities

I am aware of other alternatives to my current work

I use relaxation and meditation practices to transform stressful or negative attitudes towards my work

I value myself for who I am, not just for what I do

I believe the work I do enhances the wellbeing of others

I enjoy expressing myself through activities such as art, dance, music, drama, sport and make time to do so

I regularly exercise my creative side

when appropriate I can have fun even before my work is done

I can make most of my work into play

I allow myself to do nothing

at times I can sleep late without feeling guilty

the work I do is rewarding to me

I am proud of my accomplishments

I create opportunities for my creative, intuitive self to be expressed

Learning new things is fun for me

I do not turn my play activities into work

I have a playful attitude and the people around me support my playfulness

I enjoy playful activities with my friends

I am happy to engage in play activities with myself

Section 8: Communicating

My communications with others are clear and concise

I can leave my mobile unattended when out with friends

I initiate conversations

I am aware of my negative judgements of others and accept them as simply judgements not necessarily true

I am able to listen to objectively consider opposing viewpoints

I listen to understand, rather than respond

I clearly express my thoughts and feelings instead of assuming others can read my mind or intentions

I am not responsible for keeping others happy

I respond to others in conversation instead of trying to change the subject to seem more knowledgeable

I am aware of my defence mechanisms and can set them aside when appropriate

I am listen to people without interrupting them or finishing their sentences for them

In conversation I can introduce a difficult topic and stay with it until we reach an appropriate conclusion

I strive to be truthful and direct in my communications, and avoid playing manipulative psychological games

I am aware that absolutes, generalizations, labels and judgements undermine clear mutually beneficial common

I am a good listener

I acknowledge and apologize for any mistake I make

I ask if my help is wanted before offering it

I am sensitive to my own and other people's tone, facial expressions and body language when communicating

I recognise that humans are not the only species on the planet that have complex communication patterns

I pay attention to the information given by my environment

I try to connect to others as equals when communicating

I am comfortable with pauses in verbal communication

I am aware that sometimes people just want to be heard rather than have me fix their issues

Section 9: Sex and Intimacy

I have educated myself to make responsible, caring decisions about my sexual practices

I am comfortable, respectful and appropriate when speaking about sexual issues

I am aware that unrealistic expectations of sex are a source of dissatisfaction and unhappiness

I am committed to exploring my sexuality in pleasurable and positive ways

I am aware of the serious nature & frequency of sexual abuse and report any such incidences appropriately

I feel good about my body

It is okay to masturbate

I am aware of a powerful mind-body-spiritual connection in sex

I enjoy my body and the sensations of which it is capable of both sensually and sexually

I am comfortable with my own sexual orientation

I honour the rights of those with different sexual orientation other than my own

I acknowledge the sovereignty of my body and I am able to say no to unwelcomed sexual advances

I understand that whilst sexuality is important and pleasuralbe I am more than my sexuality

I experience my sexuality being in harmony with my spirituality

I feel good about the degree of closeness I have with men in my life

I food good about the degree of closeness I have with women in my life

I recognize that sex and love are natural expression of my being, not comodities of limited supply

With regards to sexual practices I strongly and clearly say yes to what I want and not to what I do not want

I am comfortable to love without domination.

My sexual satisfaction is my responsibility

Section 10: Meaning and Purpose

I am aware that meanings are made up and assigned by people, not inherent in events or things

I understand that my interpretations of another's behaviour may not be accurate

I contemplate what is meaningful to me and regularly re-examine my values and priorities

I listen to my own inner guidance for meaning

I set realistic goals that support me in manifesting my hopes, dreams and aspirations

My work or profession has meaning for me

I focus my awareness in the present moment, instead of living in the past or the future

I understand that what is meaningful for me may not be meaningful for another

I accept death as a normal, natural part of life

I live in awareness that I am dying and being reborn in every moment

I am able to discuss my own death or the death of someone close with family and friends

Life is about further spiritual growth and experience

I believe my life has direction and meaning, although I am not always able to see either

I have a life purpose that fulfils me and assists others

In my daily life I find ways to serve others

I understand that it is important to allow others to assist me

I let me inner voice guide me instead of letting myself be moved by the expectations of others

There are no victims in the world, all is experience

I place importance on achieving both outward material goals and inward spiritual goals

The meaning of life is what I make it and so I chose to make it positive and affirming

The highest purpose in life is the attainment of unconditional love

I am a co-creator in my world and my experience

Section 11: Transcendence & Evolution

I enjoy practicing a spiritual discipline for personal growth

I experience synchronistic events in my life

When I am unwell I am able to consciously participate in my healing process

I am aware that my experience of the world often mirrors my beliefs about reality

Reality appears to be subjective and may be changing as I evolve and change

Whilst I don't understand all of the mysteries of my life I am a significant player in my life

I understand that somethimes my life will fall apart before significant positive change arrives

I am aware I am connected to everything in the world and what I do effects everything else and visa versa

We all live in an eco-system of interdependence.

I use the messages in my dreams to improve my life

I meditate regularly to connect with the bigger part of me

I consciously seek to develop and trust my intuition

I am able to accept confusion and paradox as part of my spiritual journey

I am curious about the nature for reality

I am open to the unexplained or miracles in my life

I am comfortable knowing things without previously learning them

I believe there are dimensions of reality beyond verbal description or human comprehension

I believe everyone has a right to express their own version of spirituality

I trust and use the part of myself that has a greater wisdom than my conscious mind

I experience merging my consciousness with a larger part of me

I believe that how I think and act contributes to the wellbeing of the planet

I believe I can change my reality by changing my thoughts and beliefs

My health and wellbeing is shaped by my thoughts, beliefs, attitudes and feelings

I understand that there is no right or wrong in my world only what I allow

those who I am closest to me often mirror the parts of myself that I need to change as well as admire

I constantly strive to reach my full spiritual potential

I am aware that there is a difference between religion and spirituality

I am aware of my unique gifts, talents and skills that I have available to share with the world

I understand that I am unique, there is no one better than or worse than me

I am aware that personal growth requires my own personal effort and commitments

I am a very good observer of my own behaviour

I am aware that we all have an individual responsibility to improve ourselves in order to change the world

I believe I can change my reality by changing my thoughts and beliefs

I understand the concept of interdependence

I am aware that my mind, body and spirit are one

I am aware that my conscious mind is only a very small part of the total me

I strive to be open, honest, loving and accepting of the differences I see in others and myself

Its okay for me to have both male and female traits

I am aware that gender roles are social constructs and I am not obliged to follow them

I am aware that change on any level does not come by doing the same thing over and over

I am aware that change on any level is often uncomfortable and take effort

I regularly stretch my mind and imagination by reading different concepts and ideas

I enjoy discussions that expand my concept of reality and what is possible

I am aware that time only exists according to my belief and experience of it

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