Forks Feet Fingers Stress Sleep & Love

Forks / Feet / Fingers / Stress / Sleep / Love

Water (example of serving =  8 oz)         

How many servings daily?     0     1     2     3     4     5     more than 5

Beans (examples of servings =  ¼ cup hummus / ½ cup beans / 1 cup fresh peas)

How many servings daily?     0     1     2     3     more than 3

Cruciferous Vegetables like arugula, bok choy, broccoli, brussels sprouts, cabbage, cauliflower, collard greens or kale (examples of servings =  ½ cup / ¼ cup sprouts)

How many servings daily?     0     1     2     more than 2

Greens like lettuce or spinach (examples of servings =  1 cup raw / ½ cup cooked)

How many servings daily?     0     1     2     more than 2

Other Vegetables like mushrooms, sweet potatoes or tomatoes (examples of servings =  ½ cup cooked / 1 cup raw)

How many servings daily?     0     1     2     more than 2

Whole Grains like oatmeal, brown rice, bread (examples of servings =  ½ cup oatmeal / 1 cup cold cereal / 1 tortilla or slice of bread / half a bagel / 3 cups popcorn)

How many servings daily?     0     1     2     3     more than 3

Berries (examples of servings =  ½ cup frozen or fresh / ¼ cup dried)

How many servings daily?     0     1     more than 1

Other Fruit like avocados, bananas or apples (examples of servings =  1 medium / 1 cup /  ¼ cup dried) 

How many servings daily?     0     1     2     3     more than 3

Flaxseed, Chia Seed, or Hemp Seed (serving size 1 tablespoon)

How many servings daily?     0     1     more than 1

Nuts & Seeds (examples of servings =  ¼ cup nuts or seeds / 2 tablespoons of nut or seed butter)

How many servings daily?     0     1     more than 1

Herb & Spices (example of serving =  ¼ teaspoon dried)

How many servings daily?     0     1     more than 1

How many days a week do you exercise?     0     1     2     3     4     5     more than 5

For how long do you exercise?     15     30     45     more than 45 minutes 

Do you spend time outdoors?     Daily     Sometimes     Not often

Tobacco use     Never     Sometimes     Daily     type  ______________

How long do you sleep at night?     less than 5hrs     5     6     7     8     more than 8hrs

How often to you meditate or contemplate or pray?     Daily     Sometimes     Not often     Never

For how long?     15     30     45     more than 45 minutes

Do you have a creative outlet?     Art     Craft     Writing     Music     Other Passion

How often do you find time to be creative?     Daily     Sometimes     Not often     Never

What are your connections?     Friends     Family     Nature     Spiritual

How do you manage your stress?

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Word Document of this handout

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