Valued Living Questionnaire

First Name
Last Name

Instructions:

1st box: Rate the "importance" of each life area on a 10 point scale.

2nd box: Rate the "quality" of each life area on a 10 point scale.

"0" means the area is not at all important to you and the quality of your life in this area is as bad as it can be.

"10" means the area is very important to you and the quality of your life is the best it can be in this area.