Wellness Status and Health Behavior Questionnaire

  • There are many known aspects of life that greatly influence your well-being and your health. These factors will influence how fast you can heal. This questionnaire seeks to determine how well you feel these various aspects of your life are currently going, and what lifestyle choices or behaviors you currently undertake that would improve your health and well-being.
  • SECTION A – Your current wellness status

    Instructions: Please answer ALL the scales, based on how you have felt on average; in other words, the majority of the time in the past week. For each 0-10 scale the end-descriptors of 0 and 10 are described under each question. If you feel like you experience equally both extremes then you can tick the box labeled 5, or you may feel you are closer to one extreme than the other.










  • Section B - Your current health promoting behaviors

    Instructions: Please answer ALL the scales, based on how often you participated in the following wellness behaviors during the last week. For each question, options are from 'Never' to "Every Single Day" are offered, choose your answer accordingly.










  • This field is for validation purposes and should be left unchanged.