Self-Assesment

Physical Health Assessment
#
Questions
Yes
No
1.
I eat three balanced meals a day and drink adequate fluids.


2.
I exercise 30 minutes 3 times a week.


3.
I enjoy exercising.


4.
I exercise with a friend.


5.
I rarely eat between meals.


6.
I sleep 8 hours a night.


7.
I wake up refreshed most mornings.


8.
I sleep soundly without waking up during the night.


9.
I receive appropriate medical care and follow my physicians recommendations


Write a simple plan to improve:



Intellectual Health Assessment
1.
I read at least one book a month on a topic that interest me.


2.
I have a hobby I enjoy.


3.
I belong to a club or organization


4.
I have a 401k or 403b savings plan for retirement.


5.
I have invested in a mutual bond fund.


6.
I have invested in a mutual stock fund.


7.
I know how much money I have invested in Social Security


8.
I have a money market account


9.
I keep current with the world and national happenings


Write a simple plan to improve:



Emotional Health Assessment
1.
I don’t often get angry.


2.
When I do get angry, I keep my anger under control.


3.
I laugh every day.


4.
My friends make me laugh.


5.
I reward myself for something every day.


6.
I avoid addictive substances and behavior, such as viewing pornography.


7.
I live my life consistent with gospel principles.


Write a simple plan to improve:


Social Health Assessment
1.
I go out with my friends at least once a week.


2.
I see my family ast least twice a month and treat them with love and respect.


3.
I communicate clearly with family members and strive to keep lines of communication open.


4.
I have one friend I can confide in.


5.
I have some friends who are very different from me.


6.
Not all of my friends are nurses.


7.
I do volunteer work?


8.
I contribute in positive ways to my neighborhood and/or community.


Write a simple plan to improve:



Spiritual Health Assessment
1.
I pray or meditate every day


2.
I believe in, and have developed a relationship with Heavenly Father and Jesus Christ.


3.
I attend meetings at a place of worship regularly.


4.
I spend time each day in quiet contemplation.


5.
I read spiritual books (scriptures)


6.
I listen to spiritual audiotapes


7.
I attend church and/or the temple regularly.


Write a simple plan to improve: