I have used this simple questionnaire for our 5000 clients worldwide before their biofeedback assessments. The correlation between the questionnaire results, biofeedback results and CBC blood test results was over 90% suggesting that life-style and stress management correlates with our physical, mental and emotional wellness.
Your Wellness IQ Test
Never= 0; Sometimes=5; Always=10
1. Eating habits: Less sodas/sugar/flour/Fats; More veggies, fruits, whole grains.
2. Drinking habits (2 L daily). Pure alkaline water + half a teaspoon of lemon.
3. Alkaline pH >7.3 by eating more alkaline foods and less acid foods.
4. Exercise habits: 30 min. of aerobic + weight training three times per week.
5. Healthy deep breathing habits from the belly not shallow chest breathing.
6. Deep sleeping habits no later than 10 PM.
7. Stress management skills. Daily meditation and relaxation.
8. Healthy relationship/social skills.
9. Daily supplements of vitamins, minerals and antioxidants (high potency).
10. Minimizing usage of medications and exposure to toxic household products.
The Total Wellness Index Score
Min= 0 ; Sometimes= 50 ; Daily=100
Your wellness IQ Score
<50 = illness; 50-70=so so; >80=Wellness
If your score is under 50 please follow these dietary recommendations:
Recommended: [MORE]: raw or steamed vegetables, fruits, lean organic chicken/fish, whole grains, seeds, sprouts, beans, legumes, herbs, herbal tea, plain yogurt, nuts in moderation, high fiber foods
Not recommended: [LESS]: white flour/ gluten/rice/ sugar/ bread/ pasta/Junk/fried foods/ dairy/ sodas/ coffee/ alcohol.
Essentials: more O2, more H2O, deep sleep, supplements, laughter, exercise, love, massage, and detoxification.
Add 1 tsp of lemon to your water daily. Use olive oil/apple cider vinegar and lemon in salads daily.
Wellness EQ [Emotional Intelligence] Test
1. I am optimistic about life 10 [Always] 5 [Sometimes] 0 [Rare]
2. I am happy about my career 10 5 0
3. I am happy about my relationships 10 5 0
4. I handle daily stress well 10 5 0
5. I am a lifelong learner 10 5 0
6. I am good at problem solving 10 5 0
7. I handle conflicts well 10 5 0
8. I respond well to criticism 10 5 0
9. I get along well with others 10 5 0
10. I love myself /others unconditionally 10 5 0
Total Score: 100 [Excellent]; 50 [Fair]; 0 [Poor]

Author's Bio: 

Dr. George Grant, who is known as The Caring Doctor, is considered the Canadian authority in integrative medicine and a global wellness ambassador. Dr. George Grant is an expert in biofeedback, stress, anti aging and natural pain management.Dr. Grant
He is the founder & CEO of the Academy Of Wellness.
Dr. Grant enjoys a stellar academic and a fascinating career in research. He is a scientist, professor, chemist, toxicologist, nutritionist, biofeedback, stress management and a pain specialist. Dr Grant worked as a Senior Consultant for Health Canada, FDA and CDC as well as in private practice.
Dr. George Grant has helped 9 Fortune 500 companies, 9 non profit organizations and 9 Olympic athletes along with 5000 clients worldwide. He has over 100 published articles, conference presentations, book reviews and 9 bestselling books.
http://www.your101ways.com