Freedom Quiz Survey

Answer each statement ‘True’ or ‘False.’

The statement is either COMPLETELY TRUE or you are to mark it as "False".

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* 1. Address

Name

Email Address

Phone Number

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* 2. I practice taking care of myself first knowing that successfully managing my life requires me to be well physically, emotionally and mentally.

True

False

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* 3. I exercise regularly, at least 20 minutes 3 times per week.

True

False

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* 4. I eat healthy meals a minimum of 3 times a day and don’t skip breakfast.

True

False

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* 5. I get regular physical health check-ups, go to the dentist, and take preventative health precautions to remain well.

True

False

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* 6. I don’t feel overwhelmed and I have an effective way to keep track of and manage all the things not currently scheduled in my calendar.

True

False

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* 7. I make personal, quiet time for myself, whether I’m meditating, reading for pleasure or simply letting my thoughts wander.

True

False

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* 8. I regularly engage in activities I love to refresh my mind or body that provide enjoyment, stimulation, amusement or pleasure.

True

False

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* 9. I take regular time off from my work including at least 3 weeks of vacation per year and at least one full day a week where I don’t touch work.

True

False

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* 10. I spend regular, quality time with family and friends that enriches my life.

True

False

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* 11. I feel happy most of the time and experience being content and joyful most of the time.

True

False

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* 12. I contribute my time, energy and experience to achieve or cause things in the world that makes a difference and that matter and are important to me.

True

False

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* 13. I notice, listen to and take appropriate action when I experience the emotional signals that tell me I’m out of balance. For example: avoidance, irritability, overwhelm, resentment or worry.

True

False

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* 14. I listen to, honour and respond to the requests my body makes for things like a nap, a walk, healthy food, a hug, a massage, etc.

True

False

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* 15. When I notice I’m beginning to feel unwell, I stop and take the time I need to take care of myself.

True

False

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* 16. I only schedule meetings that forward my top priorities and have a powerful relationship to saying ‘no’ to requests for my time. I can say ‘no’ when something doesn’t fit with my priorities or goals.

True

False

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* 17. I have regular date times with my significant other or find time to date if I am single.

True

False

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* 18. When I have something planned for myself, I don’t just toss that aside when someone makes a request of me.

True

False

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* 19. I have clutter-free environments surrounding me at home and work that promote peace, growth, health, progress and clarity.

True

False

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* 20. I commit regular time to improve my knowledge, talents and potential that forwards the realization of my dreams and aspirations.

True

False

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* 21. I have a powerful relationship to my finances and a clear, viable plan to take care of my and my family’s needs after I plan to stop working.

True

False