MoonDragon's Alternative Health Information
WELL-BEING QUESTIONNAIRE

Different aspects of life can undermine health or support and enhance it. Certain physical factors or psychological strains like an unhappy relationship increase susceptibility to illness. You can increase your resilience by identifying these traits and making the necessary changes in your life. These may be in the realm of "Body", such as diet or exercise, or "Mind", for example finding ways to handle stress or difficult emotions. This questionnaire is designed to enable you to find out more about the different aspects of well-being.

Print out the entire questionnaire and check off the boxes that apply to you most. Return to the beginning and add up your scores for each section of questions. Write your score in the boxes that are provided at the bottom of each column. For each section read General Guidance to find out about the significance of the questions you have answered. Then read Your Score to evaluate the individual aspects of your well-being.

BODY PHYSICAL WELL-BEING A = Usually B = Sometimes C = Never    1. Do you feel well and energetic? A B C    2. Are you physically fit enough to do the things you want to? A B C    3. Are you free of unexplained physical symptoms? A B C    4. Do you get all the sleep you need? A B C    5. Do you exercise for at least 20-30 minutes three times a week? A B C    6. Do you give yourself time to warm up and cool down before and after exercising? A B C    7. Are you comfortable about your weight, shape, and physical condition? A B C    8. Given a choice do you walk or use the stairs? A B C TOTAL A_______ B_______ C_______ GENERAL GUIDANCE Physical fitness helps all the body systems function at their best and is important for the prevention of major diseases. It also boosts energy, helps reduce stress and benefits emotional well-being. Obesity results from lack of exercise as well as overeating, and places you at risk of developing diabetes, stroke, arthritis, and other diseases. YOUR SCORE A - Plenty of A's show you are doing your best. B - If you have mostly B's, find more ways to build exercise into your life. C - A high C score indicates that you seldom feel energetic. Before you start an exercise program, get a medical checkup. RISK-TAKING A = Never B = Sometimes C = Frequently    1. Do you smoke? A B C    2. Do you use potentially dangerous recreational drugs? A B C    3. Do you have more than three alcoholic drinks a day if a man, or two if a woman? A B C    4. Do you take risks when driving (such as drinking alcohol, speeding, not wearing a seatbelt)? A B C    5. Do you smoke in bed? A B C    6. Do you carry a weapon? A B C    7. Do you take part in dangerous sports? A B C    8. Are you careless when working with toxic or flammable substances? A B C TOTAL A_______ B_______ C_______ GENERAL GUIDANCE Taking unnecessary risks can endanger not just your life but those of others and it increases stress and emotional problems. YOUR SCORE A - A majority of A scores indicates a well adjusted approach to life. B - If you scored mostly B's, think about re-evaluating your lifestyle in those areas. C - Mostly C's could mean you are unaware of potential dangers, emotionally disturbed (if so, see your health care provider), or have a risk-taking personality (see psychotherapy & counseling). If you answered C to questions 1-3, you may have a problem with substance addiction. NUTRITION A = Usually B = Sometimes C = Never    1. Do you eat a well-balanced, low-fat diet with high fiber foods and plenty of fresh fruits and vegetables? A B C    2. Do you keep your daily fat intake below 30% of calorie intake? A B C    3. Do you keep your salt and sugar intake down? A B C    4. Do you eat poultry and fish rather than red meat? A B C    5. Do you drink enough fluids to keep your urine pale yellow? A B C    6. Do you rarely skip meals? A B C    7. Do you resist eating when not hungry? A B C    8. Do you avoid junk food and processed food? A B C    9. Do you refrain from following diet fads? A B C    10. Do you minimize your caffeine intake (coffee, tea, cola)? A B C TOTAL A_______ B_______ C_______ GENERAL GUIDANCE What you eat and drink provides energy for cell growth, maintenance, and repair, and for physical and mental activity. A diet low in fats and high in fiber, fruits, and vegetables can protect against disease. Junk and processed foods are low in fiber and high in fats, added sugars, and chemical additives. Fad diets may take weight off, but are difficult to maintain and pounds lost are quickly regained. YOUR SCORE A - If you scored A's, you are doing all you can through diet to ensure well-being. B - If you scored mostly B's, you should pay more attention to what you eat and drink. C - If you scores are mostly C's, your diet is unhealthy and you need to learn more about nutrition. FAMILY HEALTH A = No B = Yes Do you have a close relative (parent, sibling, offspring) who has had any of the following:    1. Treatment for high blood pressure? A B    2. A heart attack before the age of 40? A B    3. Very high cholesterol? A B    4. Diabetes? A B    5. Gout? A B    6. Glaucoma? A B    7. Breast cancer? A B    8. Bowel cancer? A B TOTAL A_______ B_______ GENERAL GUIDANCE Inheritance predisposes you to some diseases, and certain conditions are passed on in the genes. Even if close relatives lived to an old age, remember that genetic advantages can be undone by an unhealthy lifestyle. YOUR SCORE A - If you scored A's, you may be less at risk of inherited disease, but be aware of the Red Light Symptoms and ensure that you have regular checkups. B - If you scored any B's, talk to your health care provider to arrange appropriate health checkups, and to be advised of symptoms to watch out for. BODY MAINTENANCE A = Yes B = No    1. Do you floss your teeth daily? A B    2. Do you have an annual dental checkup? A B    3. Do you avoid over-exposure to the sun and use sunscreens when appropriate? A B    4. If you are ill or injured, do you know what to do? A B    5. WOMEN: Do you have a cervical (pap) smear at least every three years? A B    6. WOMEN: Do you check your breasts for lumps and changes every month? A B    7. MEN: Do you check your testicles for lumps and changes at least every three months? A B    8. OVER 40: Do you get a glaucoma test at least every four years? A B    9. OVER 40: Do you get your blood pressure checked annually? A B    10. OVER 50: Have you discussed an occult blood stool test with your health care provider? A B    10. OVER 50: Do you get a regular mammogram? A B TOTAL A_______ B_______ GENERAL GUIDANCE Regular health checkups are important, particularly as you get older, to identify potential problems while a cure is still possible. While this is especially true if any close relatives have been treated for inherited diseases, environment and lifestyle contribute to many serious illnesses and can exacerbate any genetic predisposition. YOUR SCORE A - If you scored high in A's, you are monitoring you health well. B - If you scored mainly B's, you need to learn more about risk factors and how to examine yourself for symptoms. Discuss health screenings with your health care provider. WORK & ENVIRONMENT A = Usually B = Sometimes C = Never Work encompasses any regular daily activities, including work in the home.    1. Are you well enough to work every day? A B C    2. Do you feel secure and satisfied in what you do? A B C    3. Do you feel valued and recognized? A B C    4. Do you feel you have resources you need? A B C    5. Do you get along with the people you deal with? A B C    6. Do you feel you are learning and developing? A B C    7. Do you look forward to your work day? A B C    8. Is your environment free from pollution (air, noise, chemicals)? A B C    9. Do you feel in control of your workload? A B C    10. Do you sit, stand, or move at work in ways that minimize strain on your back, joints, muscles, and eyes? A B C    11. Do you take enough breaks during the day to keep your mind alert and reduce body tension? A B C    12. Are you happy with your commute between home and work? A B C    13. Do you feel that those closest to you at home are supportive of your work? A B C TOTAL A_______ B_______ C_______ GENERAL GUIDANCE Feeling stimulated and fulfilled in your daily work is an important part of emotional well-being. As well as the nature of the activity itself, the conditions in which you operate are important for both physical and mental health. Although global or national environmental factors may be beyond your control, there is often a lot you can do to minimize risks in the home or workplace. YOUR SCORE A - If you scored high in A's, you should feel on top of your work and find it enjoyable and satisfying. B - A high B score indicates that you would be well advised to examine your job and workplace to find areas for improvement. C - If you scored high in C's and are unable to control your working conditions, perhaps you should consider the possibility of changing your job because it could be affecting your health. Seek out information about stress and emotions that may be helpful. WELL-BEING QUESTIONNAIRE LINKS Well-Being Questionnaire... Page 1 Well-Being Questionnaire... Page 2 Well-Being Questionnaire... 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