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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:

22. Surgeries:

23. Chronic disease:

24. My vision:

25. How strong am I physically?

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