True
False
Physical
I get adequate sleep and rest.
My basic nutritional needs are met.
I have a place to live that provides warmth and shelter and I am physically
comfortable.
Exercise and recreation needs are met through regular routines and
planned activities.
My need for sexual expression is fulfilled.
Safety and Security
With very few exceptions, I feel secure and safe from harm.
There is adequate stability and routine in my life.
I experience financial security and a sense of prosperity that isn't
based on money.
I feel emotionally safe.
I can expect consistency and fairness in my daily life.
My need for meaningful work is filled.
Love and Belonging
I feel lovedimportant, wanted, valued, and desirable.
I am able to love myself as well as others.
I have intimate or affectionate relationships with significant others.
I have a sense of belonging in my family.
I am able to understand others and feel understood by them.
I have a few very close friends and a larger circle of other friends
and associates.
I am involved in communities such as clubs or teams, church or spiritual
groups, professional, cultural or social organizations.
Though I am sometimes alone, I don't often experience loneliness.
Esteem of Self and Esteem of Others
I feel competent and up to the rigors of day-to-day life.
I live with integrity and respect for myself.
I trust my opinions, my thoughts and ideas, and my intuition.
I have confidence in my abilities and myself.
My self-care includes physical, emotional, intellectual, and spiritual
aspects of my life.
I feel useful and I make valuable contributions to others.
I experience feelings of independence and freedom.
I feel respected and appreciated by others.
Self-Actualization
I have a sense of living with purpose.
I am able to take risks and meet new challenges.
My need to be true to my own nature is being fulfilled.
I experience a feeling of peace and well-being most of the time.
My deepest desires are being realized.