Physical health
1. I have enough energy for the activities that matter to me. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
2. I move my body in ways that support my strength, flexibility, or stamina. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
3. I choose foods and drinks that generally support my well-being. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
4. I make time for rest and respond to my body’s need for care. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
Environmental health
5. My home or personal space helps me feel safe, comfortable, or restored. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
6. I spend time outdoors or in contact with nature. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
7. I make choices that show respect for the environment. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
8. My surroundings generally support my health and well-being. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
Mental health
9. I experience moments of peace of mind during my usual week. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
10. I can find something to feel hopeful or optimistic about. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
11. I make time for activities that feel meaningful or enjoyable. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
12. I can use humor or perspective when facing everyday challenges. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
Emotional health
13. I can recognize what I am feeling. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
14. I can express my feelings in a way that feels honest and appropriate. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
15. I allow myself to experience difficult feelings without judging myself for having them. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
16. I can forgive myself or others when I am ready. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
Spiritual health
17. I experience gratitude, joy, love, or a sense of connection in daily life. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
18. I have a practice or source of meaning that helps me feel grounded. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
19. I can find moments of trust or courage when I feel uncertain. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
20. I feel connected to an inner source of strength, compassion, or guidance. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
Social health
21. I feel connected to people who matter to me. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
22. I make time to nurture family, friendship, community, or intimate relationships. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
23. I have someone I can turn to for support or honest conversation. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily
24. I offer care, encouragement, or support to others in ways that feel healthy for me. Choose 0–5 0 — Never 1 — Seldom 2 — Occasionally 3 — Often 4 — Regularly 5 — Daily