Wellness Wheel Assessment

This series fo questions helps us explore different areas of your life that contribute to your overall well-being and satisfaction. My approach to care combines medication management with brief psychotherapy and a holistic understanding of you as a person. Your responses will help me better understand your strengths, challenges, and goals so we can work together to support your personal growth, emotional health, and overall well-being.

Date

Name

First Last

Date of Birth

Physical(Required)

Am I taking care of my physical health, sleep, nutrition, and activity?

Emotional(Required)

Can I recognize and manage my emotions effectively?

Social(Required)

Do I feel connected to others and have supportive relationships?

Intellectual(Required)

Am I learning, exploring interests, or engaging in mentally stimulating activities?

Occupational or Educational(Required)

Do I find meaning and satisfaction in my work, educational path and/or daily activities?

Financial(Required)

Do I feel reasonably secure about my financial situation?

Environmental(Required)

Does my living environment support my health and well-being?

Spiritual(Required)

Do I feel a sense of meaning, purpose, and/or connection to my values?

Please comment on any of these areas that are of particular concern to you and why:

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