Vitality Fitness Scorecard™

Name
Email Address
Telephone

Your Vitality Fitness Goals:

1. Do you exercise at least 2-3 times a week?	Yes No
2. Do you set aside at least one hour a day for self-care?	Yes No
3. Do you have a positive attitude?	Yes No
4. Do you get at least 7 to 8 hours of sleep per night?	Yes No
5. Do you eat healthy foods?	Yes No
6. Do you drink more than 1 or 2 alcoholic beverages per day?	Yes No
7. Do you drink at least 8 glasses of water per day?	Yes No
8. Do you take vitamins everyday?	Yes No
9. Do you eat red meat more than once a week?	Yes No
10. Do you eat 6 small meals a day?	Yes No
11. Do you have a life partner?	Yes No
12. Do you feel loved and cared for by your family?	Yes No
13. Do you feel older than you really are?	Yes No
14. Do you feel motivated to achieve your goals?	Yes No
15. Do you look forward to making positive changes in your life?	Yes No
Total:

15 points – Excellent Vitality! (Keep up the good work and commitment to your health and well-being!)

9-14 points – Average Vitality (Can use some improvement in self-care.)

0-8 points – Poor Vitality (Need to make immediate changes.)