Wellness Plan HiddenWellness AssessmentConsidering the physical parts of my life, over the past 2 days my quality of life has been 1. Bad quality of life 2. Somewhat bad 3. Neutral 4. Pretty Good 5. Excellent quality of life Considering the emotional parts of my life, over the past 2 days my quality of life has been 1. Bad quality of life 2. Somewhat bad 3. Neutral 4. Pretty Good 5. Excellent quality of life Considering the social parts of my life, over the past 2 days my quality of life has been 1. Bad quality of life 2. Somewhat bad 3. Neutral 4. Pretty Good 5. Excellent quality of life Considering the spiritual parts of my life, over the past 2 days my quality of life has been 1. Bad quality of life 2. Somewhat bad 3. Neutral 4. Pretty Good 5. Excellent quality of life Considering the financial parts of my life, over the past 2 days my quality of life has been 1. Bad quality of life 2. Somewhat bad 3. Neutral 4. Pretty Good 5. Excellent quality of life How many hours a day do you spend on technology (Computer, Phone, TV, etc.)? I watch some TV every now and then, but do not spend hardly any time with technology. Not too much time at all, definitely less than an hour or 2 a day. A moderate amount of time, most days probably 2-5 hours. Technology is part of my job, so I spend anywhere from 5-10 hours on my computer/phone a day. I spend more than hours a day on technology. Rate the amount of stress in your personal life. 1. Little to no stress. 2. 3. A moderate amount of stress, depending on the day. 4. 5. My life has me stressing out basically all day, everyday. How would you rate your overall energy? 1. Little to no fatigue. 2. 3. A moderate amount of fatigue, depending on the day. 4. 5. An extraordinary amount of fatigue. Rate the amount of stress in your career. 1. Little to no stress. 2. 3. A moderate amount of stress, depending on the day. 4. 5. My job has me stressing out basically all day, everyday. Hidden3 Tools placeholderHave you previously completed the NCCN Distress Thermometer? Yes No ECOG Scale Yes No HiddenSupport CornerstoneIn an effort to help people better, can you tell us in just a few words the biggest concern you have today and if it is related to your cancer diagnosis?
