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Wellness Questionnaire
3. How would you describe your current physical health?
Excellent
Good
Fair
Poor
3. How many days per week do you engage in physical activity for at least 30 minutes?
o
1-2
2-3
5 or more days
5. How would you rate your sleep quality?
Poor
Fair
Good
Excellent
6. How balanced do you feel your diet is?
Very balanced
Somewhat balanced
Not very balanced
Poorly balanced
7. How often do you consume processed or fast food?
Rarely
1-2 times per week
3-4 times per week
Daily
8. How much water do you drink per day?
Less than 2 glasses
2-4 glasses
5-7 glasses
8+ glasses
9. How often do you feel stressed?
Rarely
Sometimes
Often
Always
11. What are your primary sources of stress? (Check all that apply)
12. How do you usually cope with stress?
13. How would you rate your mental clarity and focus?
Excellent
Good
Fair
Poor
14. Do you feel a sense of purpose and fulfillment in your daily life?
Yes
No
Somewhat
14. Do you feel a sense of purpose and fulfillment in your daily life?
Daily
A few times per week
Occasionally
Rarely
16. How strong is your support system (friends, family, community)?
Very strong
Somewhat strong
Weak
Nonexistent
17. How comfortable are you asking for help when needed?
Very comfortable
Somewhat Comfortable
Uncomfortable
I rarely ask for help
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