Quality of Life Assessment

Take two different colored markers and with the first color circle the number that best represents how happy you are with the quality of this component in your life right now. Take the second color and circle the number that you would ideally like it to be. It is possible that you may already be at your ideal number in some areas. If so, give yourself a pat on the back; you are already managing some parts of your life well!



Family (low) 1 2 3 4 5 (high)

Romance (low) 1 2 3 4 5 (high)

Friends (low) 1 2 3 4 5 (high)

Exercise/Physical Activity (low) 1 2 3 4 5 (high) Nutrition (low) 1 2 3 4 5 (high)

Health (low) 1 2 3 4 5 (high) Humor/Fun (low) 1 2 3 4 5 (high)

Continuing Education (low) 1 2 3 4 5 (high)

Financial Planning (low) 1 2 3 4 5 (high

Career/Job (low) 1 2 3 4 5 (high)

Home (low) 1 2 3 4 5 (high)

Self/Personal Growth (low) 1 2 3 4 5 (high) Spirituality (low) 1 2 3 4 5 (high)