At Home

Is your family satisfied with the amount of time you spend with them each week?

Yes
No

Does your family have regular meetings to discuss chores, errands, and other family topics?

Yes
No

Do you communicate your expectations about household responsibilities in a positive way?

Yes
No

Do you plan and prepare meals in advance?

Yes
No

At Work

Do you have long-term career goals?

Yes
No

Do you understand and agree with your employer's expectations of you?

Yes
No

Is the number of hours you spend at the office sufficient to complete your job?

Yes
No

Is your income sufficient to support you and your family?

Yes
No

Leisure Time

Do you follow a regular exercise program?

Yes
No

Have you taken a vacation in the last year?

Yes
No

Do you take time to develop your personal interests, such as gardening, crafts and education?

Yes
No

Do you feel comfortable taking time for yourself, without your spouse or children?

Yes
No