Faith Assessment

General Instructions
Test Questions
Demographic Information
Your Results

General Instructions

This questionnaire measures some of your faith-related attitudes, beliefs and practices that may have an impact on your health. Your responses may be used by a member of our staff to have a dialogue with you regarding faith and health should you desire. If you are uncomfortable providing a response to any statement, just skip that item.

For each item, please select the option that best describes your answer. All information will be kept confidential.

YOUR BELIEFS & ATTITUDES ABOUT GOD

1. There is a connection between a person’s spirit, mind, emotions and body.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

2. A person’s faith-related beliefs, attitudes and practices can have a positive impact on their health.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

3. I am open to learning how faith-related beliefs, attitudes and practices might impact in a positive way on my health.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

4. I obtain strength and comfort from my faith/spirituality.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

5. Aside from my frequency of attending worship services, I consider myself to be spiritual.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

6. My faith gives me a strong sense of meaning and purpose.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

7. There is a God.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

8. God’s Spirit lives in me.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

9. My spiritual beliefs affect absolutely every aspect of my life.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

10. My trust and faith in God gives me hope.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

11. God hears me when I cry out to Him.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

12. My thought patterns impact on my emotions, feelings and associated behaviors.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

YOUR RELATIONSHIP WITH GOD

13. My relationship with God is the foundation for how I live my life.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

14. My relationship with God gives me a strong sense of purpose and meaning.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

15. I love God in a personal way.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

16. God loves me in a personal way.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

17. I know that God forgives me.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

18. I trust in God and have faith that He will take care of me.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

19. I try my very best to understand the principles and commandments of Holy Scriptures/the Bible.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

20. I am obedient to the principles and commandments of Holy Scriptures/the Bible.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

21. I am not harboring bitterness toward God for bad things that have happened to me.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

HOW YOU PRACTICE YOUR FAITH

22. I have close relationships with others in my faith community who have influence in my life’s direction.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

23. I feel a strong sense of support from other people who are in my faith community.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

24. I engage in healthy behaviors to care for my body as God’s temple.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

25. I draw special strength/power from God’s Spirit to make health-related behavior choices and changes in my life.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

26. I tend not to hold grudges for a long time when people hurt me.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

27. I have forgiven myself for things that I have done wrong.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

28. I have forgiven those who have hurt me.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

29. I am not angry or bitter towards God, myself or others.(Required)

Strongly Disagree

Moderately Disagree

Slightly Disagree

Unsure

Slightly Agree

Moderately Agree

Strongly Agree

30. I cry out to God when I need His help.(Required)

Never

About once a year

Several times a year

About once a month

2-3 times a month

About once a week

More than once a week

31. I attend religious services, activities or Bible studies.(Required)

Never

About once a year

Several times a year

About once a month

2-3 times a month

About once a week

More than once a week

32. I confess my wrongdoings/sins to God and ask for His forgiveness.(Required)

Never

About once a year

Several times a year

About once a month

2-3 times a month

About once a week

More than once a week

33. I volunteer at my place of worship or in my community.(Required)

Never

About once a year

Several times a year

About once a month

2-3 times a month

About once a week

More than once a week

34. I consciously surrender or “let go” of all aspects of my life to God.(Required)

Never

About once a year

Several times a year

About once a month

2-3 times a month

About once a week

More than once a week

35. I engage in social interaction with others of my faith(Required)

Never

About once a year

Several times a year

About once a month

2-3 times a month

About once a week

More than once a week

36. I monitor my thinking/thought patterns as a way to influence my emotions, feelings and associated behaviors.(Required)

Never

Less than once a month

2-3 times a month

About once a week

Several times a week

Once a day

More than once a day

37. Other than at mealtime I pray, meditate, or talk with God.(Required)

Never

Less than once a month

2-3 times a month

About once a week

Several times a week

Once a day

More than once a day

38. I read or study Holy Scriptures/the Bible privately.(Required)

Never

Less than once a month

2-3 times a month

About once a week

Several times a week

Once a day

More than once a day

39. Would you like a member of our staff to talk with you about your responses and suggest how certain Christian-principled ‘spiritual exercises’ might help make a difference with your health?(Required)

Yes

40. What is your current religion, faith and/or denomination?

Demographic Information

Please take a moment to answer the following optional questions. Your answers are totally anonymous—we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you.

You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click "View Results" to receive your screening results.

Are you taking this test for yourself or for someone else?

For Myself

For Someone Else

About You

Age Range

Zip/Postal Code(Required)

General Instructions

YOUR BELIEFS & ATTITUDES ABOUT GOD

YOUR RELATIONSHIP WITH GOD

HOW YOU PRACTICE YOUR FAITH

Demographic Information

About You

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