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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refrigerator worthy!