Emotional Health and Wellbeing Self-assesment

10 Pillars for Health, Emotional Well-being and Happiness

1. Resilience: Being able to bounce back quickly from adversity and life’s upsets

2. Having compassion, kindness and understanding versus judgment of others

3. Confidence: keeping one’s heart open, having trust and belief in the good of oneself and others

4. Healthy relationships: mastering empathic listening and speaking - being closely connected with a supportive and loving family and community

5. Healthy Sense of Self: having a high degree of self-confidence, self-esteem and self-worth

6. Easily returning to an inner state of balance and peace

7. Enjoying healthy levels of stress

8. Being able to delay short term gratification for long term gain

9. Being an excellent communicator: getting one’s wishes, needs and desires across, being understood clearly and having patience to understand others

10. Social responsibility: having a purpose and vision that goes beyond oneself and contributes to the betterment of others and the world

Name

First NameLast Name

Email

example@example.com

1. How would you rate your level of ...

	1	2	3	4	5	6	7	8	9	10
Self-confidence
Self-esteem
Self-worth
Self-image
Self-trust

2. Trauma

Did you have any traumas in your life? If yes, how did you deal with them?

	1	2	3	4	5	6	7	8	9	10
If you think of them now, how intense do you feel about them?

3. Patience

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How patient and understanding are you at work?
How patient and understanding are you at home?

4. Discipline and Self-Control

What areas are the most difficult for you to delay instant gratification for long term gain?

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How persistent and consistent are you?

What frustrates and irritates you most about people?

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How easily do you overcome failure and defeat?
How easily do you bounce back from upsetting situations?

5. Boundaries

Do you have healthy boundaries?

Are you satisfied with your boundaries?

	1	2	3	4	5	6	7	8	9	10
How effective are they?

6. Communication

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How effective is your communication at work?
How effective is your communication at home?
How confident do you feel in dealing with the negativity of others?
How much do you dislike conflict?

7. Anxiety and Worry

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How high is your anxiety level on a daily basis?
How much fear are you experiencing every day?
How easily can you relax and stop your mind from racing?

What is your #1 worry?

What is your #1 self-sabotaging tactic or behaviour?

Imagine if you could live your life all over again, what specific person or event would you prefer to skip?

Are you satisfied with your boundaries?

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How much harmony do you feel inside?
How much harmony do you feel around you?

What are your favourite excuses to explain the areas that are not working in your life?

What are the secondary gains, payoffs, or advantages for keeping your problems?

8. Depression

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Level of Frozenness
Level of being Stuck and Blocked
Level of being Traumatized
Level of Non-acceptance of trauma that has happened
Level of Hope
Anger towards self
Anger towards others
Anger towards specific person
Anger towards specific situation
Level of Courage
Level of Resilience
Addiction to Victimhood
Addiction to Poor me
Refusal to get better
Level of hopelessness
Fear level
Level of trust in oneself
Level of belief in oneself
Level of distrust in oneself
Level of disbelief in oneself

What is your #1 fear?

What is your #1 coping mechanism to feel better?

What are the disadvantages of getting better?

What are the advantages of getting better?

9. Work Related Issues

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Love for work/job
Aversion against work
Trauma at work
Conflict at work
Communication issues at work
Co-workers conflict
Co-workers harmony

Any specific incidents?

Any specific work issues?

Jeanine Crombé

International EFT Expert Trainer

Authentic Feminine Success Mentor

Founder of EFT for Life Academy

Published EFT Author

www.EFTforlife.com

www.AuthenticFeminineSuccessWithEFT.com