• Wellness Questionnaire

    Certain aspects of our habits, our lifestyles, and our environments can make each of us more or less vulnerable to the negative effects of stress. How vulnerable are YOU to stress? For each of the following 20 questions, rate how much of the time each applies to you.

    Answer the following questions by rating your behavior on a scale of
    1 (Almost Always) to 5 (Never).

    1. Do you eat at least one hot, balanced meal a day? 1 2 3 4 5
    2. Do you get 7-8 hours of sleep, at least 4 nights a week? 1 2 3 4 5
    3. Do you give and receive affection regularly? 1 2 3 4 5
    4. Do you have at least 1 relative within 50 miles on whom you can rely? 1 2 3 4 5
    5. Do you exercise to the point of perspiration at least twice a week? 1 2 3 4 5
    6. Do you smoke less than half a pack of cigarettes a day
    (non-smokers = almost always)?
    1 2 3 4 5
    7. Do you drink fewer than 5 alcoholic drinks a week?
    (non-drinkers = almost always)?
    1 2 3 4 5
    8. Are you the appropriate weight for your height? 1 2 3 4 5
    9. Do you have an income adequate to meet your basic needs? 1 2 3 4 5
    10. Do you get strength from your religious/spiritual beliefs? 1 2 3 4 5
    11. Do you regularly attend club or social activities? 1 2 3 4 5
    12. Do you have a network of friends and acquaintances? 1 2 3 4 5
    13. Do you have at least 1 friend in whom you confide about personal matters? 1 2 3 4 5
    14. Are you in good health (including eyesight, hearing, teeth, etc.)? 1 2 3 4 5
    15. Are you able to speak openly about your feelings when angry or worried? 1 2 3 4 5
    16. Do you have regular conversations with your housemates about domestic problems? 1 2 3 4 5
    17. Do you do something fun at least once a week? 1 2 3 4 5
    18. Are you able to organize your time effectively? 1 2 3 4 5
    19. Do you drink fewer than 3 caffeine drinks a day? 1 2 3 4 5
    20. Do you take quiet time for yourself during the day? 1 2 3 4 5
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