Health Assessment Form P&M Day 28

  • Rate yourself for each category using the rating system below to score yourself.

    0 to 3: Low energy, feeling overwhelmed, not functioning well, poor food choices.

    4 to 7: Feeling/performing OK; some healthy choices, room to improve.

    8 to 10: Feeling/performing well, making healthy choices, steady improvement.

  • Vitality Indicator

  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
  • Please enter a value between 1 and 10.
    (Based on the number of cups per day - the more you drink the lower your score)