Life Satisfaction Assessment

Life Satisfaction Assessment:

How would you rate your stress in the past three months?

Extremely high Very High Somewhat High Moderate Low I'm not feeling stressed at all

How much time do you spend per week taking care of yourself?

Does sleep count? Who has time for that? Not a lot Some At least 30-minutes per day I'm a self-care superstar!

What are your primary sources of stress and/or burnout? (please select all that apply)

Work Family Friends Significant Other Health School/Education Self-talk/Inner Critic Anxiety Other

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your physical health?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your mental health

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your skills development and personal learning curriculum?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your family interactions?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your friend interactions?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your finances?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with the amount of playfulness in your life?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your responsibilities and routines?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your overall alignment with your mission and values?

1 2 3 4 5 6 7 8 9 10

On a scale of 1 to 10 with 10 being the highest, where would you rate your satisfaction with your career?

1 2 3 4 5 6 7 8 9 10

First Name

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Life Satisfaction Assessment:

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