First Name

Last Name

Email *

I feel emotionally supported by others in my life.

Always

Sometimes

Rarely

I find it easy to express what I’m feeling.

Always

Sometimes

Rarely

I feel overwhelmed or anxious…

Always

Sometimes

Rarely

I feel overburdened and resentful...

Always

Sometimes

Rarely

I feel free to pursue my personal interests.

Always

Sometimes

Rarely

I get 7+ hours of sleep.

Every Night

A Few Nights A Week

Almost Never

I move my body intentionally (exercise, stretching, walking)...

Regularly

A Few Times a Week

Rarely

I fuel myself with nourishing and balanced meals...

I eat well and hydrate every day

Some of the time

Almost never

I have enough natural energy to manage my daily life.

Every Day

Most days

I rely on caffeine, sugar or naps to push through

My head and body hurts...

Regularly

Sometimes

Rarely

I feel in control of my money.

Yes

Somewhat

Not at all

I have a plan or system for managing money...

Yes

Somewhat

Not at all

Money is a source of stress for me...

Yes

Somewhat

Not at all

I feel confident about my financial future.

Yes

Somewhat

Not at All

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