The SELF, INC. Assessment is an easy way to get an accurate snapshot on how we are doing with the three departments that make us up. There is the body, mind and spirit department. After answering each question candidly, make sure to fill out all the fields at the bottom of the form.
The SELF, INC. Support Team will provide a % of capacity that each department is running at. The results are meant to give someone the opportunity to dig deep inside their way of living and bring to the forefront areas that need improvement. When balance starts to develop between the departments, that is when recovery starts becoming a reality and attainable.
1. Do you exercise aerobically (i.e. anything that raises your resting heart rate)?
3. What would you consider your overall physical health to be?
4. Do you consider yourself to be:
5. Do you consider yourself to be:
7. Do you feel like you sleep enough at night?
8. Do you spend time outside in the sun and the fresh air?
9. How would you rate your overall eating habits?
10. Do you consider the environment that you usually eat in:
12. When you are eating, are you usually:
13. When you are eating, do you stop eating:
14. Do you notice your food when you are eating?
15. Do you fast in order to detoxify?
16. How would you describe the food/beverage that you eat/drink?
17. Do you drink alcohol?
18. Do you smoke (i.e. cigars, tobacco cigarettes, clove cigarettes)?
20. Do you abuse legal/illegal and/or prescription drugs?
23. Do you use artificial sweeteners?
24. Do you eat fast food?
25. Do you eat junk food (i.e. chips, cookies, candy, soda)?
26. Do you drink beverages with caffeine?
27. How much red meat (i.e. beef, pork, lamb) do you eat?
28. How much seafood do you eat (i.e. salmon, tuna, shrimp. lobster, crab)?
29. How much chicken do you eat?
32. Do you eat nuts and grains?
33. Do you drink fruit and/or vegetable juices?
34. Do you take vitamins?
35. Do you eat/use processed foods (i.e. white floor/bread/baked goods, white sugar)?
36. Do you allocate enough time to the BODY DEPARTMENT?
31. Do you eat vegetables?
1. What kind of inner-dialogue occurs in your mind?
2. Do you do any form of meditation or relaxation techniques (i.e. yoga, mantras)?
3. Are you in tuned with your emotions and state of mind throughout the day?
4. Would you categorize yourself as one who is in good spirits?
5. Do you feed your mind with positive affirmations (i.e. I am loved)?
6. Do you recognize negative emotions and states of mind?
7. How do you respond to negative emotions and states of mind?
8. Do you use positive dialogue to combat negative thoughts (i.e. I am not worthy is combated with I am worthy)?
9. Do you use positive imagery (i.e visualize yourself as a successful business owner or in a happy relationship)?
10. Are the shows that you watch on TV the kind of shows that make you feel good?
11. Is the music you listen to the kind of music that makes you feel good?
12. Are the things that you read the kind of things that make you feel good?
13. Describe the overall organization of your home:
14. How would you describe the environment of your home?
15. Describe the overall simplicity of your home:
16. Do you utilize organizational tools (i.e.to do lists, calendar, time management system, computer, filing cabinet)?
17. Describe the overall organization of your work space at the office or at home (if you work at home):
18. Describe the overall simplicity of your work space at the office or at home (if you work at home):
19. How would you describe the environment of your work space at the office or at home (if you work at home)?
20. Do you consider the people that you surround yourself with to be:
21. Do you consider the situations and circumstances that you surround yourself with to be:
22. Do you bring work home from the office or do you work too many hours in your home office (if you work at home)?
23. Are you a goal-setter (i.e. list of things you would like to achieve and accomplish. short-term as well as long-term)?
24. Do you take time out for yourself (i.e. read a book. take a walk, journal)?
25. How do you describe the environment of your social space (i.e. friends, family, entertainment)?
26. Do you follow a daily schedule?
27. Do you consider your overall way of life to be:
28. Do you make an effort to spend 'quality' time (including writing letters, talking on the phone) time with your spouse or partner?
29. Do you make an effort to spend 'quality' time (including writing letters, talking on the phone) time with your children?
32. Do you have good handle on your finances (i.e. keep a budget, save, invest, donate)?
33. Do you try to control things that are out of your control (i.e. people and their behavior, feelings, beliefs, opinions)?
34. Do you consider yourself a perfectionist?
35. Are you hard on yourself or do you beat up on yourself?
36. Do you allocate time to the MIND DEPARTMENT?
31. Do you make an effort to spend 'quality' time (including writing letters, talking on the phone) time with your friends?
30. Do you make an effort to spend 'quality' time (including writing letters, talking on the phone) time with your relatives?
1. Describe your relationship with God?
2. Do you put God first in your life?
5. Do you tell God what is troubling you?
6. Do you ask God to help you?
8. Do you thank God for the blessings in your life?
9. . Do you thank God for the struggles in your life?
10. Do you pray for others?
11. Do you share in other people's joys and blessings?
12. Do you pray for yourself?
13. Do you commune with God throughout the day?
14. Do you pray to God for forgiveness of any mistakes that you make or have made?
15. Do you except forgiveness from God for the mistakes that you make or have made?
16. Do you forgive yourself for the mistakes that you make or have made?
17. Do forgive others for the mistakes they make or have made against you?
18. Do you share your spiritual life with others?
19. Do you express your love for God to others?
20. Do you go to a special place to spend time with God (i.e. church)?
21. Do you look to God for guidance?
22. Do you fast from certain pleasures in life so that you can experience more spiritual enlightenment?
23. Does your life express evidence of spiritual enlightenment such as love, joy, peace, patience, kindness, goodness?
24. Do you recognize easily the presence of negative energy in your life?
25. Do read literature that contains language and/or images that would be considered immoral?
26. Do you watch shows (ie.e. movies, live shows, TV shows) that would be considered immoral?
27. Do you listen to music that would be considered immoral?
28. Do associate with people exhibiting immoral behavior?
29. Do read literature that gives you spiritual enlightenment?
32. Do you use the gifts and talents that you have been born with to help yourself and others?
33. Are you aware of the presence of negative energy in the world?
34. Do you combat negative energy with positive action and/or words?
35. When you are around a person or situation that is negative, do you let it affect you or do you counteract what is happening by applying your own positive energy (i.e. someone is really down on their luck and you remind them of how special they are)?
36. Do you allocate enough time to the SPIRIT DEPARTMENT?
31. Do you strive to exhibit love for yourself and others?
30. Do you apply spiritual principles to your life (i.e. love others as you love yourself)?
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2. Do you do strength exercises (i.e. anything that increases muscle strength)?