Wellness Questionnaire

Below are 12 statements with which you may agree or disagree. Using the scale provided, indicate your agreement with each statement by choosing the appropriate score.

  • 1.My relationships with my friends are.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 2.My relationship with my family/spouse/life partner is.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 3.My relationship with other people (neighbours/ colleagues) are.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 4.I am happy with my overall body fitness.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 5.My eating/drinking habits are not good.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 6.I have a good exercise routine.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 7.I am satisfied with my appearance.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 8.I am confident person.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 9.I am not satisfied with my life.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 10.I am contented with the way I handle challenges of life.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 11.I am happy with my ability to bounce back after a problematic situation.
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory
  • 12.My mind does not seem to work too well under stressful situation
    •   Extremely satisfactory
    •   Satisfactory
    •   Neither satisfactory nor dissatisfactory
    •   Dissatisfactory
    •   Extremely dissatisfactory

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