Health and Well-being Survey

Please rate your current levels of satisfaction in the following areas on a scale from 0-10. 0 represents completely dissatisfied and 10 represents completely satisfied.

1. Safety 🔲
2. Physical activity 🔲
3. Sleep 🔲
4. Eating Well 🔲
5. Positive close relationships 🔲
6. Financial support 🔲
7. Positive places 🔲
8. Fun and leisure 🔲
9. Boundaries 🔲
10. Stress management 🔲
11. Self-awareness 🔲
12. Self-management 🔲
13. Communication 🔲
14. Continuous learning and growth 🔲
15. Decision-making 🔲
16. Managing thoughts and emotions 🔲
17. Focus 🔲
18. Positive identity 🔲
19. Clear sense of values 🔲
20. Clear sense of goals 🔲
21. Confidence 🔲
22. Positive contributions 🔲
23. Performance 🔲
24. Achievements 🔲
25. Perseverance 🔲
26. Social skills 🔲
27. Academic or job skills 🔲
28. Self-motivation 🔲

Which of these areas stand out as something you'd like to work on during our time together? 

Let's set some coaching plan goals.

1. I want to..................
2. I want to..................

Example goal statement: I want to learn how to manage my stress in healthy ways.

Tip: Coaching goals are actionable, tangible, and measurable.
• Example intangible goal: I want to be happier.
• Example tangible goal: I want to identify what makes me happy.