Wellness Checklist

Quick lifestyle checklist. Once complete, we'll have a brief snapshot and follow-up with you.
MM slash DD slash YYYY
A copy of this checklist will be sent to this email address in .pdf format.
I have SOMEONE to TALK to when my stress level is high.
I have a PLACE to WRITE THINGS DOWN when my stress level is high.
I have a way to RELAX:
I have HEALTHY FOOD on hand:
List as many as you have.
My APPETITE has significantly changed lately:
On average, my SLEEP PATTERNS are:
I am taking MEDICATION as prescribed:
I know what to EXPECT from my MEDICATION:
I am involved in SOCIAL ACTIVITIES:
My friends are aware of my NEEDS:
I am considerate of the NEEDS of my FRIENDS:
I have a HOBBY or OTHER ACTIVITY where I feel comfortable:
Overall, I feel like I'm improving MY SKILLS required for the HOBBY or OTHER ACTIVITY:
I feel like sometimes my HOBBY or OTHER ACTIVITY requires more TIME than I can afford:
I feel like sometimes my HOBBY or OTHER ACTIVITY requires more MONEY than I can afford: