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Instructions: For each category, rate how peaceful you feel on a scale of 1 to 5, where 1 = Not at all peaceful and 5 = Completely peaceful.

Please keep track of your answers to total at the end

How peaceful do you feel in your relationships with family, friends, and other important people in your life? *

1 - Not at all peaceful

2

3

4

5 - Moderately peaceful

6

7

8

9

10 - Completely peaceful

How peaceful do you feel when it comes to managing and expressing your emotions? *

1 - Not at all peaceful

2

3

4

5 - Moderately peaceful

6

7

8

9

10 - Completely peaceful

How peaceful do you feel about the state of your home, belongings, and physical surroundings? *

1 - Not at all peaceful

2

3

4

5 - Moderately peaceful

6

7

8

9

10- Completely peaceful

How peaceful do you feel about the structure of your daily schedule and your ability to manage tasks? *

1 - Not at all peaceful

2

3

4

5 - Moderately peaceful

6

7

8

9

10 - Completely peaceful

How peaceful do you feel about your self-care and how well you manage your own needs most days? *

1 - Not at all peaceful

2

3

4

5 - Moderately peaceful

6

7

8

9

10 - Completely peaceful

Your Peace Score

Full Name *

Email *

After you hit submit, please check your email. If you don't receive an email in 10 mins, please check spam

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