Mindset and Mood
| I feel very self motivated, it is easy for me to set tasks for myself and complete them | 1 |
| I am comfortable with expressing my anger or frustration | 3 |
| I can accept and embrace new challenges very easily | 3 |
| I feel my knowledge and understanding of how to naturally maintain energy and vitality is strong | 3 |
| I rarely experience anxiety, and if it occasionally arises it quickly dissipates | 2 |
| I see my mistakes as learning opportunities | 4 |
| I frequently seek and listen to feedback | 3 |
| I have a perserverence with difficult tasks | 1 |
| I like to ask questions to help my learning | 5 |
| I find I recover easily from stressful events or interactions | 3 |
| I am comfortable with expressing my fears and personal hurt | 3 |
| Section Total | 28 |
Movement
| I enjoy participating weekly in gentle movement activity like walking, swimming, yoga, tai chi | 4 |
| I enjoy participating weekly in vigorous activtites like jogging, team sports, cycling, high energy classes | 0 |
| I engage in physical activity or body movement for a miniumum of 3x30minutes per week | 0 |
| I practice multiplanar (side to side, back and forward, rotational) exercise on a weekly basis | 0 |
| My work duties involve body movement eg. walking around on a daily basis | 3 |
| My range of movement and flexibility in my body is excellent | 0 |
| My strength and stability in my body is excellent | 0 |
| I feel I have maintained a healthy weight range for my height | 3 |
| I feel quite satisfied with my body image | 3 |
| My understanding of exercise and its benefits is quite strong | 5 |
| Section Total | 18 |
Nutrition and Hydration
| I always feel I am sufficiently hydrated and drinking enough fluids | 2 |
| My fluid intake daily, not including coffee, tea, soft drinks is 6+ glasses of water/herbal tea | 4 |
| I frequently use other fluids in my meals/intake eg. soups, stews, smoothies, fresh squeezed juices | 2 |
| My food intake has a good daily balance of fresh wholefoods eg vegetables, fruits etc. | 3 |
| I eat takeaway and fast foods 4 or less times per month | 2 |
| I feel I have sufficient time to prepare my own food at home | 3 |
| I feel I have a high level of motivation and inspiration to prepare my own food at home | 0 |
| I eat an average of 3 or more cups of fresh vegetables on a daily basis | 0 |
| I have regular bowel movements 1-2 times per day and urinary frequency approx. 5-8 times per day | 1 |
| I feel like my knowledge and understanding of food, hydration and my health is strong | 5 |
| Section Total | 22 |
Vitality
| I always average 7-9 hours uninterrupted sleep per night | 0 |
| My energy feels sufficient and full throughout the entire day | 0 |
| My overall health is excellent | 0 |
| Over the past 30 days I have had no days of feeling sad or depressed | 4 |
| I have never used medication for my sleep | 5 |
| I do not use any prescribed medications | 5 |
| I have never experienced chronic diseases eg. diabetes, heart condition, high blood pressure, asthma, respiratory ailments, cancer, digestive complaints, kidney or liver disorders | 1 |
| I drink very little (4 or less standard drinks per week) or no alcohol on a weekly basis | 5 |
| I do not rely on stimulants to keep me going each day eg. sugar, caffeine, nicotine, other | 2 |
| Section Total | 25 |
Relationships
| I have very meaningful connections with my friends, relatives and relationships in my life | 1 |
| I have a circle of friends/family who love and appreciate me for who I am | 3 |
| I can let go of relationships that drag me down or damage me | 4 |
| My social time always has a place in my week | 1 |
| I tell people how they can satisfy me | 0 |
| I am highly responsive to returning contact made by friends and family | 0 |
| I receive enough love from people around me | 2 |
| I am open to new people and new experiences | 3 |
| I quickly correct miscommunications and misunderstandings when they do occur | 3 |
| I live life on my terms not by the rules or preferences of others | 3 |
| Section Total | 20 |
Life Balance
| My work place role / study environment have a good amount of time balanced between them | 1 |
| I consistently have adequate time, space and freedom in my life | 1 |
| I live in an apartment/home that I love | 5 |
| I live on a weekly/monthly budget that allows me to save and not suffer | 2 |
| I am consistently early or easily on time | 3 |
| My work place role / study environment is very personally satisfying | 3 |
| My work place role / study environment has a positive and supportive culture | 2 |
| I feel valued by my workplace associates | 1 |
| I have a spiritual belief/practice that supports me | 4 |
| I feel my sense of purpose in each day is quite strong | 1 |
| Section Total | 23 |
Overall Total – 136