Hindu Spiritual Wellness Counseling Assessment
Personal Information
Full Name
Date
Age
Gender
Contact Information
Spiritual Background
Describe your current spiritual or religious practices (e.g., puja, meditation, yoga, chanting).
Frequency of practice
Daily
Weekly
Occasionally
Rarely
Which Hindu traditions or philosophies resonate with you most?
Current Concerns or Goals
What brings you to counseling?
Please list your primary wellness/spiritual goals.
Assessment of Well-being (Rate 1-5)
Physical Well-being
1 (Low)
2
3
4
5 (High)
Mental/Emotional Well-being
1 (Low)
2
3
4
5 (High)
Spiritual Well-being
1 (Low)
2
3
4
5 (High)
Social/Relationships Well-being
1 (Low)
2
3
4
5 (High)
Cultural & Spiritual Practices
Describe any festivals or rituals important to you.
How comfortable are you with your current level of spiritual knowledge and connection?
Support System
Who are your primary sources of support?
Are you involved in a spiritual or religious community?
Additional Notes