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Well Being Questionnaire Template

Are you looking for a comprehensive Well Being Questionnaire to use with your clients? This template is designed to assess any mental, physical, and emotional health concerns that your clients may have.


This questionnaire covers a broad range of topics, such as lifestyle, health habits, family history, work-life balance, and more. It's easy to customize this form to tailor it to your client's individual needs and goals. Questions are designed in such a way that the answers can be used to identify any areas of concern and create an action plan for improvement.


The template also includes questions about diet and nutrition, sleep habits, physical activity, stress levels, and any other areas that may be pertinent to the client's overall health and well-being.


Your clients can fill out the questionnaire at their own pace and comfort level. You can use the information provided to gain a better understanding of your client's current health and lifestyle, and make any necessary recommendations or referrals.


This Well Being Questionnaire Template can help you to provide your clients with a comprehensive assessment of their physical and mental health, and provide them with the tools they need to make informed decisions about their well-being.

Well Being Questionnaire Template

Career:

  1. What is most positive about your career?
  2. What changes do you want to make related to your career?
  3. What are your key career goals?
  4. 4. What do you need to change to help your career move forward?

Social Well-being: having strong and positive relationships.

  1. What is most positive about your relationships and social life?
  2. What changes do you want to make related to your relationships and social life?
  3. What are your key goals related to your relationships and social life?
  4. What do you need to change to help your relationships and social life move forward?

Financial Well-being: maintaining sufficient, balanced finances.

  1. What is most positive about your financial situation?
  2. What changes do you want to make related to your financial situation?
  3. What are your key goals related to your financial situation?
  4. What do you need to change to help your financial situation move forward?

Community Well-being: feeling engaged in one's community.

  1. What is most positive about your community situation?
  2. What changes do you want to make related to your community situation?
  3. What are your key goals related to your community situation?
  4. What do you need to change to help your community situation move forward?

Spirituality: inner deep work, being spiritually nourished.

  1. What gives my life meaning and purpose?
  2. Which values do I live by, and how do I demonstrate them in my thoughts and actions?
  3. Do I find spiritual energy in a community or as an individual?
  4. What sustains me in times of need or when I am challenged?
  5. What brings me inner peace and comfort?

Physical & Psychological Well-being: living a healthy life.

  1. What is most positive about your health situation?
  2. What concerns do you have about your health?
  3. What changes do you want to make related to your health situation?
  4. What are your key goals related to your health situation?
  5. What do you need to change to help your health or a more healthy lifestyle move forward?

Personal:

  1. What special interests do you have?
  2. What special knowledge do you have?
  3. What do you believe in strongly?
  4. Tell me about a time when you were operating in a peak performance phase, when things were going really well or you were very pleased with what you were doing or accomplishing. No need to be humble.
  5. Describe what was going on, who was involved, and what feelings you had?
  6. What do you do when things get stressful?
  7. What activities have special meaning for you?
  8. What vision do you have for your life?
  9. Please share anything you would like about your family, friends and/or personal life.
  10. Please share any significant events in your life.
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