Acceptance and Commitment Therapy (ACT) Values Questionnaire Form
Reflect on your core values, life priorities, and areas for personal growth.
What are the three most important values that guide your life?
*
Which of the following life domains are most meaningful to you? (Select all that apply)
*
Family & Relationships
Career & Work
Education & Learning
Health & Wellbeing
Community & Service
Spirituality & Personal Growth
Recreation & Leisure
Other
How important are your chosen values to you right now?
*
Not important
1
2
3
4
5
6
Extremely important
7
1 is Not important, 7 is Extremely important
How consistently do you feel you are living according to your values?
*
Rarely
1
2
3
4
5
6
Almost always
7
1 is Rarely, 7 is Almost always
Reflect on each domain: How aligned do you feel your actions are with your values in these areas?
Rows
Not at all aligned
Somewhat aligned
Mostly aligned
Fully aligned
Family & Relationships
1
2
3
4
Career & Work
5
6
7
8
Education & Learning
9
10
11
12
Health & Wellbeing
13
14
15
16
Community & Service
17
18
19
20
Spirituality & Personal Growth
21
22
23
24
Recreation & Leisure
25
26
27
28
What is one area of your life where you would like to better align your actions with your values?
What is one small step you can take this week to live more in line with your values?
Which of the following best describes your current level of satisfaction with how you are living your values?
Very satisfied
Somewhat satisfied
Neutral
Somewhat dissatisfied
Very dissatisfied
Is there anything else you would like to share about your values or priorities?
Submit
Should be Empty: