I Am Well America Mini-Self Assessment

I Am Well America Self Assessment
This mini self-assessment is designed to help you identify areas where you may want or need to ask for assistance in order to achieve and maintain optimal health and wellness. For the following statements, please select the answers that best describe you at the current time, and then click "Complete". Once you click complete, you'll be provided with a PDF to review your responses. You can download this to your phone or computer for your personal use. (Cookies may need to be enabled on your browser or device for the PDF to display.)

NOTE: This tool is not for use in emergency care situations and should not replace medical advice. Please call 911, visit your nearest hospital or seek help immediately if chronic or enduring pain, shortness of breath, or other signs of distress are present.

	Always	Most of the Time	Some of the Time	Never
I can move my body with ease and do the activities that I want and am physically able to do. (without shortness of breath or pain, as quickly as I want)
My body is free from aches and pains.
I can breathe fully and freely with ease.
I am fully hydrated and drink at least 64 ounces of water each day.
My urine is pale yellow or clear.
I eat foods that are nutritional with a balance of protein, vegetables, fruits, and carbohydrates.
I am at a healthy weight that allows me to feel good about myself, move about and do all activities I wish to do with ease.
I have regular and easy bowel movements.
My have clean teeth, healthy gums, and fresh breath
I am free from chronic disease.
(heart, kidney, lung, auto immune, diabetes, etc.)
My immune system is healthy and responsive.
I have low rates of colds, flu and other viruses or bacterial infections
If I do become ill, I recover quickly
I have healthy sleep habits and routines.
I wake up feeling refreshed, I sleep 7 to 9 hours per night
I engage in some physical activity every day such as walking, exercise, some type of movement such as dance, stretching, weights.
I am happy with my energy level I have most days.
My mind can process fully and clearly. I can make decisions in the best interest of myself and others to the best of my ability.
I have a healthy sense of identity.
I am aware of my strengths and skills as well as areas that could use improvement if desired.
I know what my values are and honor them.
I maintain my own identity in my relationships with others.
My understanding and expression of myself matches my values and boundaries.
I have healthy shared goals in my relationships
I can express the goals and desired outcomes of my relationships.
I have a strong sense of trust, respect, and commitment to achieving shared goals in my relationships.
I have the ability and commitment to resolve conflicts.
I am committed to working together to bring out the best in others.
I have healthy communication habits in my relationships.
I engage in positive and healthy interactions with others each day.
I think positive and healthy thoughts every day.
I express my feelings freely in positive and healthy ways.
I have a fulfilling sex life
I work at a job that is in line with my beliefs and values.
I take time alone to think about and decide what is important in life, who I am, what I value, where I fit in, and where I am going.
I feel comfortable and at ease in my home and community.
I consistently have a sense of hope and purpose in my life.
I make time for relaxation every day

PRIVACY AND SUPPORT: This self-assessment is intended for your personal use to identify services and resources that might be helpful for you. Please note, I Am Well America does not monitor submissions from this site and limits the collection of personally identifying information. If you are experiencing a mental health crisis, please dial 988. If you are experiencing any other emergency, please dial 911.*

I understand and agree
Should be Empty:

I Am Well America Self Assessment