Career
Health
Family
Leisure Time & Entertainment

Career
Health
Family
Leisure Time & Entertainment

Career
Health
Family
Leisure Time & Entertainment

Weight Loss & Nutrition
Fitness & Exercise
Sport Performance
Stress Management
Other

Rarely
Occasionally
Some of the time
Most of the time
All of the time

Terrible
Poor
Fair
Good
Excellent

No problem, my energy levels are great
Good, I am generally upbeat and energetic
Fine on most days
Low, I get a couple of things done everyday
Really low, struggling to get things done

No I am always at a healthy weight
Yes but I don’t have a plan
Yes but the plans I have tried are not working
Yes and the current plan I am on seems to be working

No I am active and feel my health is good at least average for my age
Yes but I don’t have a plan
Yes but the plans I have tried are not working
Yes and the current plan I am on seems to be working