QUESTIONS Often = 4 points Regularly = 3 points Sometimes = 2 points Rarely = 1 point

1) How often do you have difficulty breathing?

2) How often do you feel unsafe at home?

3) How often do you find yourself holding your breath?

4) How often do you unsafe at work or school?

5) How often do you find yourself worrying?

6) How often do you have difficulty paying attention?

7) How often do you think negative thoughts about yourself?

8) How often do you dwell on past failures?

9) How often do you worry about the future?

10) How often is your mind overactive with thinking?

11) How often do you feel disconnected from your body?

12) How often do you feel a lack of support from others around you?

13)How often do you feel numb and insensitive?

14)How often do you feel weak or tired?

15) How often do you feel agitated and out of balance?

16) How often do you feel apathy and/or despair?

17) How often do you have less than thirty minutes of daily exercise or
intense physical activity?
18) How often do you feel lazy and unmotivated?

19) How often do you have difficulty in starting a new task or project?

20)How often do you have difficulty in completing a task or project?

21) How often do you not express what you feel and think?

QUESTIONS Often = 4 points Regularly = 3 points Sometimes = 2 points Rarely = 1 point

22) How often do you feel misunderstood by others in what you tell
them?

23)How often do you find yourself in poor rapport with others?

24) How often do you feel controlled or manipulated by others?

25) How often do you try to control and manipulate others to get what
you need or want?
26) How often do you feel stressed out?

27) How often do you have upsets with friends or family?

28) How often do you feel resentment or anger from events which
happened in the past?
29)How often do you feel a sense of guilt or self-loathing?

30) How often are you unable to get a good nights' sleep?

31) How often do you feel like your life lacks real meaning and purpose?

32) How often do you eat sweets and other sugary drinks or snacks?

33) How often do you have two or less fruits and vegetables per day?

34) How often do you feel you aren't living a heart directed life?

35) How often do you eat junk food?

SUBTOTALS
TOTAL

RESULTS
35 to 55 Points means Excellent. Please Watch Purple Video
56 to 85 Points means Very Good. Please Watch Green Video
86 to 115 Points means Poor. Please Watch Yellow Video
116 and above means Terrible. Please Watch the Red Video