WellbeingBlend Questionnaire ||Categories: Menu Pages| Name: Full Address: Postcode: Tel No: Mobile: Email: Occupation: Date: 1.Do you see yourself as a strong person in your relationships at home? Yes No Do you see yourself as a strong person in your relationships at work? Yes No Would you like to find it easier to relax? Yes No Please SELECT the proportion of your day that you normally feel stressed:0%10%25%50%75%100% 2. Do you tend to feel you need to rush things? Yes No Do you like to take your time and do things well? Yes No How many hours a week do you Cardiovascular exercise?0-2 hours3-4 hours5-7 hours8-10 hours10+ hours What type? 3. How many times a week are you in touch with friends on the internet? How many times a week do you physically meet up with friends? Do you tend to try to make things right for them? Yes No How many hours a week do you take time off for you or things you enjoy doing? Hours What is the average number of hours of sleep which you get per night? Hours 4. Is it important to you to have clear goals and achieve then? Yes No Do you find it hard to get motivated? Yes No Do you find it hard if you are criticised? Yes No Or do you think – “Well that’s their problem if they don’t like what I’ve done. I’m OK with me. Yes No 5. Do you enjoy structure in your life? Yes No Do you like to be spontaneous? Yes No Do you enjoy having brain storms and creating new ideas? Yes No Do you think you have a positive attitude to your everyday niggles in life? Yes No 6. Please list 3 values which are important to you – whatever comes into your head is fine. 1. 2. 3. Do you feel you have a clear sense of purpose? Yes No Do you run out of time to do the things you want to do? Yes No Do you feel you are the boss at home? Yes No What are the 2 emotions which you are aware you feel most? 1. 2. 7. Do you consider you have a spiritual base or belief system which you call upon for help and support? Yes No Please describe what gives you a sense of purpose in life. What activities/hobbies have meaning or “heart” for you? Do you participate in voluntary community activities? Yes No 8. Have you ever had problems with your heart? Yes No Has your blood pressure been high for a while at any time? Yes No Detail any current or past illness or reasons for regularly having to visit your GP. 9. What do you do to reduce stress in your life? Running, friends, nature, exercise, cars… What do you do which is meaningful to you to help you relax and take time for you? 10. Is there one person/people who you can count on for emotional support/help with a decision? Yes No Is it easy for you to get angry or irritated? Yes No Do you get sad/unhappy easily? Yes No Can you get anxious in challenging situations? Yes No Do you tend to feel lonely. Even though you have people around you? Yes No Are you aware that you feel depressed at times? Yes No 11. Is there someone at work who is irritating you? Yes No Are you good at standing up for yourself at work? Yes No Are you good at making choices which are right for you? Yes No Are you good at celebrating when life is better/good? Yes No 12. Do you enjoy helping people? Yes No Do you like to feel that you are liked? Yes No Are people important in your life? Yes No Do you enjoy times on your own when you can simply be you? Yes No
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