Spiritual Healthy Lifestyle Assessment and Progress Chart ©

Spiritual Healthy Lifestyle Assessment ©

How much we practice Spiritual Healthy Lifestyles contributes to our spiritual inner strength and in turn our Whole Person Wellness. Use this form to help you identify what lifestyle difficulties you need to pray about and seek support for. (This form is for your private use and for sharing with others as you wish.) This questionnaire is written in a format for persons of the Christian faith. Persons of other faith can substitute what they call their Higher Power or religion where there is an asterisk (*). Use estimates/averages for numbers as necessary. (Copyright© E. Anthony Allen 2011)
1. Commitment made to follow Christ*

YesNo

2. Aids to Personal Spirituality:

	Yes	No	Times Daily	Times Weekly	Times Monthly
a. Regular renewal of one’s commitment, surrender and dependence on Christ*
b. Prayer (times per day)
c. Regular inclusion in one’s prayer of the following:
- Adoration (praise to God*)
- Thanksgiving (Gratitude)
- Confession
- Intercession (praying for others)
- Petitions(praying for personal needs)
d. Bible study:
- daily readings (times weekly)
- ongoing special bible study
e. Regular inspirational and informative reading (times per month)
f. Regular meditation and listening to God *
g. Seeking daily filling by the Holy Spirit* in one’s meditation or prayer
h. Fasting (times per month)
i. Journaling (times weekly)

3. Sharing: Spiritual support with others

	Yes	No
Prayer partner
Small support group

4. Retreating: for reflection, review and special prayer

5. Attendance at place of Worship

	#	Yes	No
Times per Month
Making regular use of activities for fellowship, education and support at place of worship

6. Voluntary Christian* Service:

	#
Times per Month
Times per Quarter

7. Regularly sharing your experiences with Christ* to help others and encourage others to depend on Him

YesNo

8. Forgiveness and Reconciliation

	Yes	No
Regular forgiveness of others
Regular efforts at reconciliation after having wronged someone

9. Living out one’s Faith: Demonstrating or experiencing “Fruit of the Spirit*”

10. Prayer for healing

	Yes	No
Seeking prayer for healing of self
I pray for the healing of others

11. Thinking in whole person terms.

	(1) none	(2) mild	(3) moderate	(4) marked
Degree

12. “Centering” Time for practicing Aids to Personal Spirituality (See 2 above)

YesNo
13. Quarterly “Spiritual check up” by using this form or an alternative

YesNo
Email
example@example.com
Should be Empty:

Spiritual Healthy Lifestyle Assessment ©