* 1. What is your age?

* 2. What is your gender?

* 3. How many years have you been in ministry?

* 4. How many congregations have you served on staff at?

* 5. How many years total have you served your current congregation?

* 6. What is your ministry title?

Physical Health

* 7. How many hours of sleep do you average per night?

* 8. Rate the quality of your sleep

0 Sleep Quality (0 = Sleepless and 100 = Sound sleep)
i We adjusted the number you entered based on the slider’s scale.

* 9. How many months has it been since you have seen a medical doctor?

* 10. How many hours per month do you spend exercising?

* 11. What is your overall feeling about the healthiness of your diet?

* 12. How satisfied are you with your physical health?

Mental Health

* 13. Have you ever experienced mental health issues as a result of ministry?

* 14. Have you ever experienced high levels anxiety as a result of ministry? (Severe enough to impair your life and/or work)

* 15. If yes, how long has it been since you experienced significant anxiety? (in months, 0 = current)

* 16. Have you ever experienced high levels depression as a result of ministry? (Severe enough to impair your life and/or work)

* 17. If yes, how long has it been since you experienced significant depression? (in months, current = 0)

* 18. How would you rate your current stress level at this point in your ministry?

0 Stress level (0 = None and 100 = Incapacitating)
i We adjusted the number you entered based on the slider’s scale.

* 19. How satisfied are you with the state of your mental health?

Relational Health

* 20. What is your marital status?

* 21. If you are currently married what is your satisfaction level with your marriage?

* 22. If you are married how spiritually connected are you with your spouse?

* 23. If you are married how has ministry affected your spouse?

* 24. Do you have children?

* 25. If yes, are any of your children living at home with you?

* 26. How would you rate your spiritual connection with your children?

* 27. If you have children how has ministry affected them?

Ministerial Health

* 28. What do you find to be the most rewarding aspect of ministry?

* 29. What is the most stressful aspect of ministry?

* 30. How many hours a week on average do you spend in ministry?

* 31. If you have elders, how would you rate your relationship with them?

* 32. If you have other ministers on staff how would you rate your relationship with them?

* 33. How many hours a week do you spend in recreation (doing something besides ministry you enjoy)?

* 34. How many hours a week do you spend studying for teaching and/or preaching?

* 35. How many hours a week do you spend in personal (not for anything public) study?

* 36. How would you describe how well you are balancing your responsibilities at work, home, etc?

* 37. How many people in the congregation do you regularly spend time with in non-ministry related contexts?

* 38. Have you ever considered leaving ministry for good?

* 39. Do you believe your next employment will be

* 40. Do you have any non-family members in your life you can confide in?

* 41. Who (besides your spouse if married) do you turn to most for personal support (emotional, spiritual, counsel, etc)?

* 42. How frequently do you go to someone for personal help?

* 43. If you had something you needed to confess to someone is there someone in your life you could do that with? (besides your spouse)

* 44. How would you describe your relationship with God at the moment?

* 45. How hopeful are you about the future?

* 46. Do you attend any events during the year for the purpose of self-care?

* 47. If yes, what kinds of events/activities do you engage in? (check all that apply)

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