Physical

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

1.

2.

3.

Social / Cultural

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

4.

5.

6.

Academic / Career

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

7.

8.

9.

Spiritual

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

10.

11.

12.

Environmental

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

13.

14.

15.

Financial

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

16.

17.

18.

Emotional

  • Never
  • Rarely
  • Sometimes
  • Often
  • Always

19.

20.

21.