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Healthy Lifestyle Log - Week 1
Please complete this weekly log to track your physical, mental, and social health for the week.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
How Many Days Did You Consume over 2,000 Daily Calories last week
*
Choose
0
1
2
3
4
5
6
7
How many days did you consume (Fast or Restaurant Food)
*
None
1 to 3
4 to 5
6 to10
More than 10
What Snacks did you consume
*
No Snacks
Chips (ex.Hot Fries, Grippos etc)
Pastries (ex.Cookies, Honey Buns, Donuts, Cake)
Candy (ex Skittles, Candy Bars, Blow Pops, Fruities)
Fruit (ex.Bananas, Strawberries, Apples, Oranges, etc.)
Required
Did you drink more water than soft drinks or juice
*
Yes
No
How many Stress-Free days did you have last week?
*
Choose
1
2
3
4
5
6
7
0
What kind of positive activity did you do to relieve stress during the week
*
Physical Fitness (ex. Sports,. Weight Training)
Leisure Activites (ex.Book Reading, Walking, Food, Cooking, Horse Play)
Recreational Activites (ex. Biking, Skating, Fishing, Hiking)
Technology Activties (ex. Cell Phone, Video Games)
Family and Friends Activites
List something positive you did or happen last week
*
Your answer
Provide a link to an article or video related to physical, mental, social, or emotional health.
Your answer
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