A symptom is a sign observed by you. It points to homeostatic imbalance. Learn more about yourself by taking the Sage Health Questionnaire.
Answer the questions in each section below and total your score. Each
response will be a number from 0 to 5.
0 = Never or almost never (once a year or less)
1 = Seldom (2 to 12 times/year)
2 = Occasionally (2 to 4 times/month))
3 = Often (2 to 3 times/week)
4 = Regularly (4 to 6 times/week)
5 = Daily (every day)
BODY: Physical and Environmental Health
- Do you maintain a healthy diet (lots of vegetables, fruits, healthy fats and proteins)?
............ - Is your water intake adequate (at least ½ oz./lb. of body weight; 160 lbs. = 80 oz.; or 10 gm/450 gm of body weight)?
............ - Are you within 20 percent of your ideal body weight?
............ - Do you fall asleep easily and sleep soundly?
............ - Do you awaken in the morning feeling well-rested?
............ - Do you have more than enough energy to meet your daily responsibilities?
............ - Are your five senses acute?
............ - Do you take time to experience sensual pleasure?
............ - Does your sexual relationship feel gratifying?
............ - Do you engage in regular physical workouts (lasting at least 20 minutes)?
............ - Do you have good endurance or aerobic capacity?
............ - Are you physically strong?
............ - Are you free of chronic aches, pains, ailments, and diseases?
............ - Do you have regular effortless bowel movements?
............ - Do you understand the causes of your chronic physical problems?
............ - Are you free of any drug or alcohol dependency?
............ - Do you live and work in a healthy environment with respect to clean air, water, and indoor pollution?
............ - Do you feel energized or empowered by nature?
............ - Do you feel a strong connection with and appreciation for your body, your home, and your environment?
............ - Do you have an awareness of life-energy or qi?
............
Total BODY Score = ............
MIND: Mental and Emotional Health
- Do you have specific goals in your personal and professional life?
............ - Do you have the ability to concentrate for extended periods of time?
............ - Do you use visualization or mental imagery to help you attain your goals or enhance your performance?
............ - Can you meet your financial needs and desires?
............ - Do you give yourself more supportive messages than critical messages?
............ - Is your job enjoyable and fulfilling?
............ - Are you willing to take risks or make mistakes in order to succeed?
............ - Are you able to adjust beliefs and attitudes as a result of learning from painful experiences?
............ - Do you have a sense of humor?
............ - Do you maintain peace of mind and tranquility?
............ - Are you free from a strong need for control or the need to be right?
............ - Are you able to fully experience (feel) your painful feelings such as fear, anger, sadness, and hopelessness?
............ - Are you aware of and able to safely express fear?
............ - Are you aware of and able to safely express anger?
............
- Are you aware of and able to safely express sadness or cry?
............ - Do you engage in meditation, contemplation, or psychotherapy to better understand your feelings?
............ - Is your sleep free from disturbing dreams?
............ - Do you explore the symbolism and emotional content of your dreams?
............ - Do you take the time to let down and relax, or make time for activities that constitute the abandon or absorption of play?
............ - Do you enjoy high self-esteem?
............
Total MIND Score = ............
SPIRIT: Spiritual and Social Health
- Do you take time for prayer, meditation, or reflection?
............ - Do you listen and act upon your intuition?
............ - Are creative activities a part of your work or leisure time?
............ - Do you take risks?
............ - Would you say you are a spiritual person?
............ - Are you grateful for the blessings in your life?
............ - Do you take walks, garden, or have contact with nature?
............ - Are you able to let go of your attachment to specific outcomes and embrace uncertainty? ............
- Do you observe a day of rest completely away from work, dedicated to nurturing yourself and your family?
............ - Can you let go of self-interest in deciding the best course of action for a given situation?
............ - Do you feel a sense of purpose?
............ - Are playfulness and humor important to you in your daily life?
............ - Do you have the ability to forgive yourself and others?
............ - Have you demonstrated the willingness to commit to a marriage or comparable long-term relationship?
............ - Do you experience intimacy, besides sex, in your committed relationships?
............ - Do you confide in or speak openly with one or more close friends?
............ - Do you or did you feel close with your parents?
............ - If you have experienced the loss of a loved one, have you fully grieved that loss?
............ - Do you feel a sense of belonging to a group or community?
............
- Do you experience unconditional love?
............
Total SPIRIT Score = ............
Total BODY, MIND, SPIRIT Score = ............
HEALTH SCALE:
260 - 300 Optimal Health
220 - 259 Excellent Health
180 - 219 Good Health
140 - 179 Fair Health
100 - 139 Below Average Health
60 - 99 Poor Health