Midlife Self-Assessment Checklist
Reflect on your current life stage and evaluate key areas to gain insight and set future goals.
Full Name
First Name
Last Name
Age
*
Gender
Female
Male
Non-binary
Prefer not to say
How satisfied are you with the following areas of your life?
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Career/Work
1
2
3
4
5
Physical Health
6
7
8
9
10
Mental Well-being
11
12
13
14
15
Family Relationships
16
17
18
19
20
Friendships/Social Life
21
22
23
24
25
Finances
26
27
28
29
30
Personal Growth
31
32
33
34
35
Work-Life Balance
36
37
38
39
40
Which of the following best describes your current life priorities? (Select up to 3)
*
Career advancement
Health and wellness
Family and relationships
Financial stability
Personal development
Travel and leisure
Community involvement
Other
On a scale of 1 to 10, how would you rate your overall life satisfaction at this stage?
*
Not satisfied
1
2
3
4
5
6
7
8
9
Extremely satisfied
10
1 is Not satisfied, 10 is Extremely satisfied
What are the top 3 challenges you are currently facing?
*
Which of the following best describes your approach to change and new opportunities?
*
I actively seek out new experiences
I cautiously consider before making changes
I prefer to maintain the status quo
Other
How often do you engage in activities that bring you joy or fulfillment?
*
Daily
Several times a week
Once a week
Rarely
What is one goal you would like to achieve in the next year?
Is there anything else you would like to reflect on or add?
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