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General Guidance

This questionnaire is designed to help you stop and think about your wellbeing today; how you are and what you can do to increase your sense of wellbeing.
It should take you around 10 mins to complete and comprises of four sections.
As you complete the questionnaire, notice your responses. Make a note of items that you score high or low. Use this to assure you of where you're doing well, and what you might need to consider to improve your wellbeing.
At the end of the questionnaire, there is an image with some suggestions on about things you might do to improve your wellbeing. These are based on our Wellbeing Triangle [link] so are organised into things you can do to help you connect with yourself, others or 'Other' (sense of God, divine, universe)

The questionnaire starts by asking you to choose an image that says something about your wellbeing. You can write as much or little as you like in this section. In the following sections, we encourage you to complete the questions quickly, relying on your gut-reactions rather than thinking too much about your answers.

This data will be collected anonymously and used by Space to Breathe to gain a better understanding of wellbeing trends at particular times.
SECTION ONE: YOUR CURRENT LANDSCAPE

Question Title

* 1. Which of these pictures say something about your wellbeing today?  

Question Title

* 2. Consider why you chose this image and jot down a few thoughts...

SECTION TWO: CONNECTION WITH SELF
These questions all relate to the extent to which you feel a positive sense of connection with your self at this time. 

Please indicate the number that best describes your experience over the last week with 1 being none of the time and 5 being all of the time.

1 none of the time
2 hardly any of the time
3 sometimes
4 most of the time
5 all of the time

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* 3. I’ve been feeling comfortable in being myself

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 4. I’ve been feeling able to use my feelings to guide my thinking and actions

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 5. I've been feeling able to engage with things that are important to me

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 6. I've been feeling able to do things that express who I am 

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.
SECTION THREE: CONNECTION WITH OTHERS

These questions all relate to the extent to which you feel a positive sense of connection with others at this time.

Please indicate the number that best describes your experience over the last week with 1 being none of the time and 5 being all of the time.

1 none of the time
2 hardly any of the time
3 sometimes
4 most of the time
5 all of the time

Question Title

* 7. I’ve been feeling loved

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 8. I've been feeling appreciated 

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 9. I've been feeling part of other people's lives

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 10. I've been feeling able to give to others

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.
SECTION FOUR: CONNECTION WITH 'OTHER'

These questions all relate to the extent to which you feel a positive sense of connection with 'OTHER' (God, the divine, the universe) at this time.

Please indicate the number that best describes your experience over the last week with 1 being none of the time and 5 being all of the time.

1 none of the time
2 hardly any of the time
3 sometimes
4 most of the time
5 all of the time

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* 11. I’ve been feeling a healthy sense of perspective 

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 12. I’ve been feeling a sense of awe and wonder

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 13. I've been feeling grateful

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 14. I’ve been feeling able to be still

1 5
Clear
i We adjusted the number you entered based on the slider’s scale.
AND FINALLY ...
Thanks for completing the survey.  We think this is a valuable tool is developing your own self-awareness and making sense of your wellbeing.  To find out some ideas about what to do next visit www.spacetobreatheuk.com/wellbeing-audit-next-steps
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