Name Email Phone How often do you engage in physical exercise? Almost every day A few times a week Rarely or never None How well do you sleep at night? I sleep soundly for 7-8 hours I get 5-6 hours of sleep with occasional disruptions I have trouble falling or staying asleep and sleep less than 5 hours None How do you handle feelings of stress or anxiety? I practice relaxation techniques like meditation or deep breathing regularly I try to distract myself with hobbies or other activities I feel overwhelmed and don’t have a specific way to manage stress None How balanced is your diet? I eat a balanced diet rich in fruits, vegetables and whole grains I try to eat healthy but have some processed foods and sugary snacks My diet is mostly processed foods and lacks variety None How often do you take time for yourself to relax and unwind? Daily A few times a week Rarely None How connected do you feel with your support system (friends, family, and community)? Very connected and supported Somewhat connected, but not always available I often feel isolated and unsupported None Do you practice mindfulness or meditation? Regularly, at least a few times a week Occasionally Rarely or never None How do you manage your work or daily responsibilities? I prioritize tasks and manage my time effectively I sometimes struggle with time management but get things done I often feel overwhelmed and behind on my responsibilities None 1 out of 2 Time's up
