I Am Well Darke County Mini Self-Assessment

This mini self-assessment tool is designed to help you identify areas where you may want or need to ask for assistance in order to achieve and maintain your own unique optimal health and wellness.

How it Works

For the following statements below, please select the answers that best describe you at the current time. Once you click "complete," you'll receive an email with a summary of your results in PDF format. Areas in "Green" indicate things seem to be going well, areas in "Yellow" indicate things that might need some attention, and areas in "Red" indicate that immediate action may be required.

Please note: This tool is not for use in emergency care situations and should not replace medical or mental health advice. For a mental health crisis, please call 988. 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

I Am Well Darke County requests your contact information so that we can send your results to you via email automatically. At the end of this section, we'll also ask you how you would like for your information to be used. If you are an I Am Well Darke County member or check the box requesting additional information, a member of I Am Well Darke County's team will follow up with you directly by phone or email within 2-5 days. (Please be sure to check your spam folders for an email from I Am Well Darke County).

If these boxes are not checked, a member of I Am Well Darke County's team will not follow up with you directly, but you may receive periodic communication from I Am Well Darke County letting you know about our services and membership opportunities. Remember, you can also contact us directly anytime at info@iamwelldarkecounty.org.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

Confirmation Emailexample@example.com

Phone Number*

Please enter a valid phone number.

Which of the following best describes your use of the mini self-assessment tool today?*

I am an I Am Well Darke County MemberI would like personalized follow up to learn more about membership, services and opportunities.I am using this tool for my personal use only and do NOT need personalized follow up at this time.

Terms of Use Agreement: This mini self-assessment is intended for your personal use to identify services and resources that might be helpful for you. By clicking "Complete" you also acknowledge that you understand and agree with the terms of use described above. 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

I Am Well Darke County Mini-Self Assessment

Contact Information & Terms of Use