Self Assessment Form
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Self-Assessment Form
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You can keep track of your daily progress using the table below. The aim is not to judge or be hard on yourself; it is just to keep you on track so you can chart your progress. This is especially helpful if you don’t have many people who are supporting you or that you can share your progress with.
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DAY 1DAY 2
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Got enough sleep?Got enough sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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Felt motivated?Felt motivated?
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Did 20 minutes of exercise?Did 20 minutes of exercise?
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Did 15 minutes of relaxation?Did 15 minutes of relaxation?
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Used affirmations?Used affirmations?
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Resisted temptation?Resisted temptation?
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Comments:Comments:
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DAY 3DAY 4
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Got enough sleep?Got enough sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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Felt motivated?Felt motivated?
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Did 20 minutes of exercise?Did 20 minutes of exercise?
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Did 15 minutes of relaxation?Did 15 minutes of relaxation?
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Used affirmations?Used affirmations?
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Resisted temptation?Resisted temptation?
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Comments:Comments:
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DAY 5DAY 6
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Got enough sleep?Got enough sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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Felt motivated?Felt motivated?
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Did 20 minutes of exercise?Did 20 minutes of exercise?
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Did 15 minutes of relaxation?Did 15 minutes of relaxation?
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Used affirmations?Used affirmations?
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Resisted temptation?Resisted temptation?
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Comments:Comments:
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DAY 7DAY 8
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Having more restful sleep?Having more restful sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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Felt motivated?Felt motivated?
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Did 20 minutes of exercise?Did 20 minutes of exercise?
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Did 15 minutes of relaxation?Did 15 minutes of relaxation?
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Used affirmations?Used affirmations?
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Resisted temptation?Resisted temptation?
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Felt more energized?Felt more energized?
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Had reduced cravings?Had reduced cravings?
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Comments:Comments:
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DAY 9DAY 10
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Having more restful sleep?Having more restful sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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Felt motivated?Felt motivated?
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Did 20 minutes of exercise?Did 20 minutes of exercise?
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Did 15 minutes of relaxation?Did 15 minutes of relaxation?
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Used affirmations?Used affirmations?
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Resisted temptation?Resisted temptation?
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Felt more energized?Felt more energized?
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Had reduced cravings?Had reduced cravings?
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Comments:Comments:
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DAY 11DAY 12
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Having more restful sleep?Having more restful sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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Felt motivated?Felt motivated?
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Did 20 minutes of exercise?Did 20 minutes of exercise?
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Did 15 minutes of relaxation?Did 15 minutes of relaxation?
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Used affirmations?Used affirmations?
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Resisted temptation?Resisted temptation?
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Felt more energized?Felt more energized?
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Had reduced cravings?Had reduced cravings?
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Comments:Comments:
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DAY 13DAY 14
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Felt great!!Resisted junk food!
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Having more restful sleep?Having more restful sleep?
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Made healthy food choices?Made healthy food choices?
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Cheated?Cheated?
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