Exit My Personal Wellness Survey Question Title * 1. My husband or wife is my best friend. Yes No Question Title * 2. How well are your eating habits and overall diet? I eat regular meals each day. I snack on healthy items like fruit and nuts. I drink too much alcohol. I have gained or lost excess weight this year. My doctor has expressed concerns about my diet. Question Title * 3. How well do you cultivate your activities related to entertainment, recreation and leisure? Very high quality High quality Neither high nor low quality Low quality Very low quality Question Title * 4. How well is your relationship with your spouse, partner, or special friend? Very easy Easy Neither easy nor difficult Difficult Very difficult Question Title * 5. How well do you sleep? I sleep soundly each night. I awaken feeling fresh each morning. There is a lot weighing on my mind that causes me to lose sleep. I like my bedroom and it is one of my preferred living spaces in my home. I feel lonely in my bed. My bedtime routine and sleep hygiene are neither established nor relaxing. I feel nurtured & happy in my bed. I am concerned about my sleeping habits. I have a memory of a bad experience in my present or a past bed. I regret an experience with someone I invited in my bed. I am not comfortable talking about past negative experiences in my bed. I feel confident to say "no" to people who wish to be in my bed with me. I trust my feelings about my preferences in bed. Question Title * 6. I prefer to travel with Partner and spouse Best friend other than partner or spouse Groups of friends Other couples Myself Question Title * 7. How well is your relationships with most of your friends? Very easy Easy Neither easy nor difficult Difficult Very difficult Question Title * 8. How well do I take of my body and exercise? I have a regular physical health and exercise program. I am in good shape for my age. I enjoy moving my body. I feel breathless when I walk a short distance. I take responsibility for how I feel in my body. My doctor is worried about my heart health. I feel responsible in my sexual relationships and sexual health. I find sex to be a chore and unsatisfying. In truth, I would prefer not to have sex with my partner, and he or she is aware of this. Question Title * 9. How well do you get along with your peers or colleagues at work? A great deal A lot A moderate amount A little None at all Question Title * 10. How well is my spiritual health? I believe in God or a higher power and pray regularly. I am spiritual but not religious. I prefer to volunteer or do random deeds of service then to belong to an institution of religion. I pray each day. Religion has been a source of problems in my family. I no longer practice the religion of my childhood. I believe that my spiritual health is a part of my overall wellbeing. I do not think it is important to believe in a higher power. Question Title * 11. How well is your financial or economic health? Extremely valuable Very valuable Somewhat valuable Not so valuable Not at all valuable Page1 / 1 100% of survey complete. Done
