Personal Health Assessment
1. How would you describe your Day to Day energy levels? *
2. My bodyweight is appropriate for my frame. *
3. I sleep soundly and wake up in the morning feeling refreshed. *
4. I consider my self-esteem and self-acceptance levels to be... *
5. I make time for myself daily so that I can focus on my health and well-being. *
6. I feel that I am strong in my beliefs and follow through on my self-commitments. *
7. I positively need to be in the best shape to live my best life. *
Your Name (required) *
Your Email (required) *
Your Phone Number (required) *
If you would like to enter any additional information please do so here
Never submit passwords through Google Forms.
This form was created inside of Manifest Weight Loss.