During the past four weeks, how much have you been bothered by personal or emotional problems (such as feeling nervous, anxious, irritable or depressed)?

During the past four weeks, how much did personal or emotional problems keep you from doing your usual physical activities?

During the past four weeks, have you been bothered by feeling down, depressed or hopeless?

My life has a strong sense of meaning and purpose.

Thinking about your life these days, how satisfied are you with it?

If working, indicate level of job satisfaction.

How would you rate the amount of control you have over your life these days?

During the past six months, have your spiritual activity levels changed?

During the past six months, I have been able to shut off distracting thoughts and be fully aware of what I am doing.

Please add any additional comments about your Spiritual wellness: