Name *

First Name

Last Name

PHYSICAL/HEALTH/WELLNESS *

Choose the answer that is most like you (or what you resonate with most) in the area.

I feel good about it; I'm content, satisfied. My health is good, could improve some.

It's not my priority; OR I havehealth issues I'm ignoring.

Sometimes I take care of it, sometimes I don't. My health is fair.

I'm in great health! I focus on my physical body & wellness regularly. This is my jam!

I know that I should focus on it, but I don't make the time for it.

SPIRITUAL *

Choose the answer that is most like you (or what you resonate with most) in the area.

I believe in “something” but it’s not really something I focus on.

What does this even mean? I feel lost in this area.

I’d definitely describe myself as spiritual, always listening, & looking for confirmations. I’m inspired by the Word. I take daily steps of faith.

I’m connected; I pray; I meditate on the Word or on positive thoughts. Scripture and positive ideas in books encourage me.

I think I know what I believe, at least for others, but I need to grow and see more of it in my own life.

RELATIONAL *

Choose the answer that is most like you (or what you resonate with most) in the area.

I’m completely satisfied with all of my relationships! I have enough quality time in my marriage, with my kids, and my girlfriends! I don’t miss date night/ sports games/ chips-n-salsa night with the girls ( 😉 for example)

I feel comfortable, but I could be more engaged. My relationships could be better, but they’re still ok.

“Meh”. I don’t see my friends much, but we keep up on social. I don’t really have time for date night, we’re too busy or our schedules don’t really work. It’s pretty much get up & go, then dinner, & bed with the kiddos.

I don’t have time for get-togethers with friends, or date nights. We don’t really have alone time for intimacy. Things always feel rushed with he kids. When I think about it, there’s not a lot of laughing going on.

We have game nights or some other fun activity together as a family at least a couple times per month. I miss some nights with the girls, but I catch up on the phone when I do. I feel pretty close with my husband most of the time, but we definitely could use some more time to be with just each other.

PROFESSIONAL *

Choose the answer that is most like you (or what you resonate with most) in the area.

I have no idea what I want to be/do. There’s really no joy in what I’m doing. I feel like I work too much or too little.

I enjoy what I do, and find some meaning in it. I’m connected & have a good time. I feel like it makes a difference when I’m there.

I’m busy but don’t feel productive or like I’m making an impact. It pays the bills but I don’t love it. I don’t really feel like I’m accomplishing anything.

I’m pretty content in what I do. I like it enough, but I could take it or leave it.

I love what I do. It lights me up. I feel alive or super accomplished at work. I feel like I’m really successful and great at what I do.

PERSONAL/SELF-CARE *

Choose the answer that is most like you (or what you resonate with most) in the area.

I’m totally into self-care. I make time for me regularly & feel really refreshed afterwards. I deserve it, so I do it.

I don’t have enough time for me/self-care, but I do know what I would do if I had the time.

What exactly is self-care? I’ve really let myself go. I put my needs last.

I spend more time taking care of others. I put myself last on the regular.

I try to do something on my self-care list at least a couple times per month but it doesn’t always work out.

FINANCIAL *

Choose the answer that is most like you (or what you resonate with most) in the area.

I'm drowning in debt/bills, & barely above water. I don't know where my next funds are coming from. One issue, like a broken appliance or needing brakes for my car, is gonna wreck everything.

I'm satisfied with my salary or returns from business; I can give at least a little to charities; I pay my tithes; I've saved a little for my future.

I live paycheck to paycheck & it's pretty tight most of the time. If I lost my paycheck, I'd be under water within 1-3 months.

I make enough to scrape by; I can barley pay bills; I sometime rob Peter to pay Paul; I sometimes miss payments or use credit cards to pay monthly bills.

I have overflow, I live in abundance; Money is not an issue most of the time; I can do whatever I want/need (within reason); I have money for vacations.