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

Other
Describe your emotional state
Physical - How do you care for your body?

Other
Describe your physical health
Socio-Cultural - A Sense of Connectedness

Other
Describe your social life
Financial - How you make and manage money

Other
Describe your financial state
Environmental - The places where time is spent

Other
Describe the environments where you spend your life
Occupational - Your work and efforts

Other
Describe your occupation
Spiritual - Honesty and Self-Awareness

Other
Describe your spirituality?
Intellectual - How you occupy your mind

Other
Describe your intellectual state
Who are you willing to speak with? (if other, please add their name and email address)

Other
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.
Signature
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