Health & Personal Wellness Assignment 1.1
Health Survey
Name:
Date:
Directions: Take the Personal Wellness Survey below. Tally your scores then answer
the questions that follow. (4 points)
Almost
Always
Sometimes
Rarely
or Never
2
2
2
1
1
1
0
0
0
Physical
Wellness
I avoid using tobacco.
I eat a variety of healthy foods each day.
I engage in 60 min of moderate exercise most days of the week.
Physical Wellness Score:
Emotional Wellness
I have good self-esteem.
I can trust other people.
I can express my feelings to others.
Emotional Wellness Score:
Intellectual Wellne
1
0
2
2.
2
1
0
0
1