Wellness and Balance Checklist

Wellness and Balance Checklist

Wellness is the result of a balanced living style that includes attention to the 8 essential areas of human growth. Please complete this form to determine how balanced your lifestyle is and what areas may need more attention.
Emotional Intelligence - Processing our Emotions

JournalingMeditatingConfessionCryingVentingFearless HonestySpeaking upSetting and Maintaining BoundariesAsking for HelpListening to Others Without JudgmentOther
Describe your emotional state
Physical - How do you care for your body?

Good Personal HygieneSportsExerciseRestful SleepMeditationFresh Fruits and VegetablesBeans, Lentils, PeasActive LifestyleDaily or Regular Self-Care PracticesVacation / SpaOther
Describe your physical health
Socio-Cultural - A Sense of Connectedness

Close FriendshipsParticipation in Group ActivitiesChurch, Synagogue, Mosque, Temple, etc.Close with RelativesSocial MediaService WorkHonesty and TransparencyOther
Describe your social life
Financial - How you make and manage money

EmploymentInvestmentsSavingsSales and CouponsBoundaries on SpendingCharitable ContributionsDiversified IncomePrioritized SpendingLimited DebtAvoiding DeadbeatsOther
Describe your financial state
Environmental - The places where time is spent

Time in NatureClean and Organized HomeSafe and Clean Work PlacePersonal Touch / DecorationsMinimalism / Avoiding HoardingClean and Maintained TransportationPlace of PeacePlace of WorshipPlace of Self-ExpressionPlaces of CelebrationDrama Free EnvironmentsOther
Describe the environments where you spend your life
Occupational - Your work and efforts

Self - EmployedRegular JobContract LaborHobbies that Generate IncomeDrama Free WorkplaceHealthy Relationship with Employer(s)Satisfied with IncomeEnjoy OccupationOn Time for WorkProductive at WorkSense of AccomplishmentOther
Describe your occupation
Spiritual - Honesty and Self-Awareness

Fearless HonestyPrayerMeditation (any form, see image)Service WorkDaily Inventory / Self-ReflectionWritten Inventory12 Step RecoveryReligious PracticesTime in NatureCrying, Venting, ConfessionRelating to Others / Listening Without JudgingOther
Describe your spirituality?
Intellectual - How you occupy your mind

ReadingFormal EducationPersonal ResearchDocumentariesProblem Solving ReasoningAsking QuestionsListening to AnswersPracticing AcceptanceEmpathyPersonal Observation and ConclusionsQuiet TimeHealthy ObsessionsOther
Describe your intellectual state
Who are you willing to speak with? (if other, please add their name and email address)

Jeff RoundsSelyna BreezeDavid WilkOther
Name

First NameLast Name
Email
example@example.com
By submitting I hereby confirm that the information I have given above is true, and that I will be receiving an email response to my submission and an invitation to discuss the results with a nonprofessional member of Mixed Recovery.
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