| Read through the A list and count your “no” answers. Then read through B list and count your “yes” answers. Add them together when you are done. | Print Page |
| Yes | No | |
| 1. Do you have a close support network of family and friends? | ||
| 2. Are you happy with your current job/profession? | ||
| 3. Do you exercise regularly (3 or more times per week)? | ||
| 4. Do you eat 3 meals and 1-2 snacks per day 90% of the time? | ||
| 5. Do you avoid entirely or consume very limited amounts of caffeine, alcohol and/or sugar and refined carbohydrates (white bread, crackers, pasta, bakery goods, cereals, etc.)? | ||
| 6. Do you take downtime to recharge your batteries-both actual trips and events and small amounts daily? | ||
| 7. Do you take a multivitamin/mineral complex daily? | ||
| 8. Are you comfortable financially? | ||
| 9. Are you satisfied with your life and its direction? | ||
| 10. Do you keep your weight within normal range easily? | ||
| 11. Do you regularly get 8 hours of uninterrupted sleep per night? |
| Yes | No | |
| 1. Are you frequently anxious or depressed? | ||
| 2. Would you rate yourself as stressed? | ||
| 3. Do you suffer from allergies, arthritis, fibromylagia, asthma or headaches? | ||
| 4. Do you have trouble falling asleep or staying asleep? | ||
| 5. Are you sensitive to smells? 6. Has your sex drive gone down? | ||
| 7. Are you more tired after exercise? 8. Are you frequently irritable, angry or upset? | ||
| 9. Have you experienced any major life stressor in the past year (death of a loved one, medical diagnosis of a loved one or personally, divorce, marriage, birth of a child, move, change of job, financial change)? | ||
| 10. Do you have trouble getting up, or making it through the day without caffeine? | ||
| 11. Do you catch colds, flu, get sick more than 3 times a year? | ||
| 12. Do you crave carbohydrates? | ||
| 13. Do you have difficulty remembering things? |