You can always press Enter⏎ to continue
Self-Assessment Questionnaire © 

Self-Assessment Questionnaire © 

How is your wellness? This screening questionnaire is intended to help you assess if you have significant challenges in any aspect of your whole person. It can guide you to decide on the appropriate action to take. Let your aim be Balanced Living and Total Healing for Whole Person Wellness. (© 2024 Dr E. Anthony Allen)
10Questions
  • 1
    1 of 5
    Press
    Enter
  • 2
    Recently, have you:
    1 of 8
    Press
    Enter
  • 3
    Are you experiencing:
    1 of 9
    Press
    Enter
  • 4
    Are you having problems in any of the following areas?:
    1 of 16
    Press
    Enter
  • 5
    Are you experiencing any of the following in your community?:
    1 of 4
    Press
    Enter
  • 6
    Have you recently experienced, or are you now facing any of the following crises?:
    1 of 5
    Press
    Enter
  • 7
    1 of 3
    Press
    Enter
  • 8
    With regard to the amount of challenges you have, indicate the number in each area as below:
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    Body
    Mind
    Spirit
    Social
    Environment
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    1 - None
    2 - Mild
    3 - Moderate
    4- Marked
    Press
    Enter
  • 9
    1 of 13
    Press
    Enter
  • 10
    To get a copy of your results, please enter your email below
    Press
    Enter
  • Should be Empty:
Question Label
1 of 10See AllGo Back
close