Free Life Evaluation

Please fill out the following questionnaire by giving yourself a rating of 1 to 10 for each question, with 1=Not so good, 10=Very Good, the life coach cannot see the results, only you can.

		<< Worse					Better >>
		1	2	3	4	5	6	7	8	9	10
1.	I eat healthy and the right amount of food in my diet.
2.	I get the time I want for myself, to relax / enjoy.
3.	I am as organized as I should be.
4.	I rate my true happiness level as...
5.	I rate my health level (taking into account: eating, exercising, substance abuse, weight, emotional stability) as...
6.	My parents were encouraging, supportive, loving and fair to me when I was a child.
7.	I would rate my love and intimacy level with my spouse or family as...
8.	I would rate my spiritual level as...
9.	a. [for young parents] My children listen to me the first time I tell them to do something. b. [for older parents] I have a close and warm relationship with my adult children (and their spouses). c. [for teens and adult children] I have a loving and warm relationship with my parents, siblings and talk to them regularly.
10.	I contribute a sufficient portion of my annual income towards retirement (experts recommend five to ten percent).