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1. When dealing with change (or any new situation), my anxiety level is:

non-existent. Looking forward to it!

low. I'm kind of nervous, but that's about it.

average. I may worry a little, but am also curious about the new outcome.

high. I worry a lot about it.

extremely high. I may have a panic attack.

2. I feel safe:

at all times.

most of the time.

about half the time. There are things that need to be resolved for me to feel safe more frequently.

occasionally. Most of the time I am scared that I may be hurt.

Never. I am scared for my life.

3. It’s easy for me to feel happy & enjoy life:

all the time

most of the time

about 50/50

some of the time

never

4. When it comes to cleanliness:

I keep things very clean and get rid of unused things on a regular basis.

I keep things mostly clean. I have a few areas that need to be cleaned out or let go of.

I do have many things that need to be let go of. I clean mainly when people come to visit.

I hoard things on a regular basis. Occasionally, I will let go of some things.

I have a difficult time letting go of anything and I live in a big mess.

5. When something goes wrong:

I acknowledge the error, take full responsibility & turn my thoughts to possible solutions

I feel bad for a short time, but am able to find a way to work through it

I feel bad, but eventually I get over it

I tend to hold on to negative feelings for a long time

I immediately find someone to blame and hold resentment towards

6. My level of confidence:

is 100%. I feel very confident in my work, relationships and health.

is about 75%. I feel mostly confident in many areas, but not all.

is about 50%. There are an equal number of things I've confident with compared to things I lack confidence in.

is about 25%. I hardly ever feel confident and my self esteem is lower than average.

is close to 0%. I feel bad, hold resentment & blame others.

7. I manage my time:

effectively. I accomplish quite a bit every day due to my habits & schedule I follow.

somewhat effectively. I get important tasks done each day, but still waste some time.

I don't really manage my time. I do things a bit haphazardly and somehow get some stuff done.

I don't manage my time. I procrastinate and feel stuck.

I don't manage my time at all. Not only do I procrastinate and feel stuck, I am always putting out fires, being sucked in to drama, and feel like I have very little control of my life.

8. I feel connected to the source of truth:

always. The inspiration I receive is accurate and timely.

most of the time. Sometimes I believe things that aren't true.

some of the time. It feels like my inspiration is about 50/50 in terms of accuracy.

hardly ever. I rely on friends, family, the media, etc to influence many of the decisions I make.

never. Not only do I completely rely on others to influence decisions for me, I also feel like its easy for me to be scammed.

9. At this time, the grief and sadness I feel is:

non existent. I am fine right now.

felt to a small degree. Everything will be ok.

a little intense at times. I am having some ups and downs.

very intense. I'm having difficulty coping with it.

the most difficult thing I have endured.

10. How often do I feel gratitude?

always

most of the time

about half (50/50)

infrequently

never

11. My thoughts & feelings include self criticism, negativity and/or depression:

never

hardly ever

50/50

often

24/7

12. The phrase, 'Life is Hard':

does not represent my life. Its easy and fun for me.

may apply to my life in certain situations. But its mostly the opposite for me.

is true about half the time. The other half, its easy & fun.

is true for the most part. Occasionally, I'll have some good days.

is completely accurate as it applies to my life.

13. How much guilt am I currently carrying around?

none. I feel completely honest & worthy.

some. I feel honest & worthy for the most part.

some, but there are an equal number of things I feel honest & worthy about.

quite a bit. I feel this way most of the time.

always. Guilt consumes my life.

14. How are addictions affecting my life?

not all all. I have no addictions.

somewhat. There are 1 or 2 small addictions, but they don't cause problems in my life.

While they may not be that serious, they are causing some problems in my life.

I do have some serious addictions that are causing major problems in my life, but not life threatening.

Addictions are controlling my life and may be life threatening.

15. I feel peaceful (and free of stress):

almost always

most of the time

sometimes

hardly ever

never

16. How is past trauma affecting my life now?

I've never had any past trauma (or if I've had trauma, its been cleared).

There is a small amount of trauma that is still affecting me.

I'm still dealing with trauma from the past. It affects me about half the time.

It negatively affects my life in a big way.

Its always affecting me and I feel hopeless about the situation.

17. When I hear a criticism:

it either doesn't affect me or I make improvements because of it.

I feel bad, but the negative feeling goes away quickly.

I take it in and it takes me several days or weeks to get over it.

I feel anger and immediately seek to defend myself.

I choose avoidance because I can't take it. It may stay with me for years.

18. How often do I experience anger?

Hardly ever

sometimes, but the feeling goes away quickly.

frequently. The anger may stay with me for minutes or hours.

frequently. The anger may stay with me for days or weeks.

I'm almost always angry about something. Yelling (and possibly physical violence) is common too.

19. I have trouble remembering:

I never have trouble remembering

every once in a while when I'm nervous

when I am pressured to recall something

during normal conversation

all the time

20. How do past failures in my life affect me?

teaches me things & provides motivation to keep trying.

makes me feel sad or frustrated, but I get over it and move on.

causes me to feel sad. Sometimes I have a hard time getting over it.

makes me feel depressed. I end up procrastinating things because of it.

typically traumatizes me and blocks my ability to move forward.

21. What do I deserve?

to experience the fullness of my hearts desires & I believe I can have it.

to have most of the nice things I want, but not all.

to have some of the nice things I want, but not sure if its possible.

to work hard and struggle for everything that is important to me.

nothing. I eliminate my wants & needs to survival only.

22. With all the tasks & projects I am expected to do currently,

I have no problem prioritizing and completing all of them.

I may delay some tasks I dislike for a short period of time.

I may delay some tasks I dislike for a long period of time.

I put the tasks off indefinitely but ultimately will accomplish them

I put the tasks off indefinitely and never complete them, even though I may start them.

I never get around to starting the tasks I dislike

23. On a daily basis, I feel fearful:

less than 1% of the time.

occasionally. I am mostly fine.

about half of the time.

between 50% to 75% of the time.

more than 75% of the time.

24. My life is best described as:

epic

pretty good

average

boring

a nightmare

25. How often do I worry?

never

rarely

sometimes

usually

always

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