The forms

Spiritual wellness self assessment

For each question, please select the number that best describes how you are feeling now on a scale of 0 to 10 (0 = total lack | 10 = secure and abundant).

Name

So I can match this form to your appointment

First Name

Last Name

Today's date

The date you are completing the assessment

MM

DD

YYYY

Upcoming session date

Please type the date of the upcoming session you've booked. (You must book a session before completing the assessments.)

MM

DD

YYYY

Sense of purpose

(0 = total lack | 10 = secure and abundant).

Sense of connection

(0 = total lack | 10 = secure and abundant).

Sense of hope and faith

(0 = total lack | 10 = secure and abundant).

Ability to cope with life's surprises, ups and downs

(0 = total lack | 10 = secure and abundant).

Sense of inner peace

(0 = total lack | 10 = secure and abundant).

Flowing and fulfilling creativity

(0 = total lack | 10 = secure and abundant).

Please describe any issues indicated above

Are there any other issues you would like me to know about?

Please rate them on a scale of 0-10 and provide any other details.

Next form: Overall well-being and focus