LEGACY GROUP WEEKLY WELLNESS FEEDBACK
NAME
Select
Adelé
Arthurnacious
Hamza
JJ
Ryan
How would you rate the presence of the following feelings or experience over the last 7 days, where 1 is nonexistent and 5 is very much and all the time. All fields are optional.
STRESS
1
2
3
4
5
GENERAL EFFICACY
ⓘ
1
2
3
4
5
POSITIVE THOUGHTS ABOUT MYSELF
1
2
3
4
5
SENSE OF PURPOSEFULNESS
1
2
3
4
5
ENERGY LEVELS
1
2
3
4
5
GROWTH/STRETCHING
1
2
3
4
5
FEELING CONNECTED
1
2
3
4
5
FAMILY ROLE EFFICACY
ⓘ
1
2
3
4
5
PHYSICAL HEALTH
1
2
3
4
5
BUSY-NESS
1
2
3
4
5
PREDOMINANT EMOTION
Happy
Playful
Curious
Thankful
Couragious
Focused
Proud
Loved
Hopeful
Excited
Bored
Angry
Frustrated
Stressed
Jittery
Afraid
Sad
Depressed
Moody
Shame
Drained
WHO ARE YOU CONNECTING WITH THE MOST?
(SELECT)
Adelé
Arthurnacious
Hamza
JJ
Ryan
WHO WOULD YOU MOST LIKE TO CONNECT WITH MORE?
(SELECT)
Adelé
Arthurnacious
Hamza
JJ
Ryan
COMPLETE
OKAY
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