1. My health is:
2. The level of stress I feel on a weekly basis is:
3. I practice deep breathing:
4. How is my energy throughout the day?
5. How is my sleep each night?
6. My exercise routine:
7. Re: my weight, I am currently:
8. My digestion is:
9. My teeth:
10. My water intake:
11. Smoking is:
12. The foods & drinks I consume are:
13. I meditate:
14. Drinking alcohol is:
15. I am pain free:
16. The health of my heart is:
17. My hair is:
18. My skin:
19. I rely on prescription meds:
20. My joints: (choose MOST significant if there are multiple)
21. My current mental/emotional health is:
23. Chronic disease:
24. My vision:
25. How strong am I physically?
26. The pain I feel is in my:
27. I feel safe ...
28. On a scale of 1- 10, what is the intensity of the pain I have
29. I feel physically energetic ...
30. My overall health and fitness level:
31. I am ___________ with my fitness level:
32. My water intake is: