How Healthy is Your Lifestyle? Question Title * 1. Information Name: City/Town Country Email Address: Question Title * 2. Age < 15 years old 16 - 30 years old 31 - 45 years old 46 - 60 years old 61 - 75 years old > 76 years old Question Title * 3. Gender Male Female Other Question Title * 4. Using any number from 0 to 10, where 0 is having no energy and 10 is having an extremely high level of energy, what number would you use to rate your energy for today? 10 Extremely high level of energy 9 8 7 6 5 4 3 2 1 0 No energy Energy Level Energy Level 10 Extremely high level of energy Energy Level 9 Energy Level 8 Energy Level 7 Energy Level 6 Energy Level 5 Energy Level 4 Energy Level 3 Energy Level 2 Energy Level 1 Energy Level 0 No energy Question Title * 5. Using any number from 0 to 10, where 0 is having no stress and 10 is having an extremely high level of stress, what number would you use to rate your stress for today? 10 Extremely high level of stress 9 8 7 6 5 4 3 2 1 0 No stress Stress Level Stress Level 10 Extremely high level of stress Stress Level 9 Stress Level 8 Stress Level 7 Stress Level 6 Stress Level 5 Stress Level 4 Stress Level 3 Stress Level 2 Stress Level 1 Stress Level 0 No stress Question Title * 6. I know and apply deep diaphragm breathing to help me relax Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 7. I eat the equivalent of three nutritious and balanced meals a day Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 8. I am physically working out/walking for at least 20 minutes a day Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 9. I am aware of my feelings and can describe that Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 10. I understand how the brain works and it helps to regulate my feelings better Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 11. I start my day being grateful Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 12. I talk in a kind and positive manner with my inner self Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 13. I participate in activities to help calm my brain (e.g., yoga, meditation) Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 14. I made a point to listen attentively to others Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 15. I spend an hour of quality time with a loved one (e.g., family or close friend) Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 16. I pay kind attention to others Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 17. I reach out to others with compassion Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 18. I know my purpose and am living it Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 19. I find positive meaning during hard times Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 20. I forgive others Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 21. I live mindful and in the moment Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 22. I bounce back when adversity happens Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Question Title * 23. I accept situations and others as they are Never (0%) Rarely (about 10%) Occasionally (about 30%) Sometimes (about 50%) Frequently (about 70%) Usually (about 90%) Every time (100%) Done