The Lifestyle Check-Up

  • MM slash DD slash YYYY
  • Optimal health requires attention to all areas. Give yourself this Lifestyle Check-Up – see what you’ve been doing well, and what might need some attention.
  • Strongly disagreeDisagreeNeutralAgreeStrongly agree
    I eat a healthy diet
    I drink 6-8 glasses (8 oz.) of water daily
    I take vitamins and/or supplements for my health
    I do not consume alcohol or I drink responsibly
    I drink little or no caffeinated beverages (e.g., coffee, tea, soda, energy drinks)
    I do not smoke cigarettes
    I do not use illicit drugs or abuse prescription drugs
    I exercise regularly
    I have regular and sound sleep
    I am in strong physical health
    I am in strong mental health
    I am comfortable with my financial health
    I engage in regular spiritual and/or religious activities
    I pray and/or meditate
    I practice stress management, relaxation, and/or mindfulness activities
    I have balance between work and other areas of my life
    I regularly practice hobbies and/or recreational activities
    I have an active social life
    I have healthy dating life or I have a healthy committed relationship or I have a healthy marriage
    I have trusted people in my life that I can talk to
    I am satisfied with my progress toward my life goals