E-mail Address: * I often eat foods that are healthy and nutritious. 1 - Less True 2 3 4 5 - More True I rarely feel tired by mid-afternoon, and use for more energy coffee, soda or a candy bar. 1 - Less True 2 3 4 5 - More True I try to include some type of cardio activity into my daily routine. (i.e. walking, running, etc) 1 - Less True 2 3 4 5 - More True I prefer to walk up one or two flights of stairs rather than take the elevator. 1 - Less True 2 3 4 5 - More True I sleep eight hours on most nights. 1 - Less True 2 3 4 5 - More True I get routine health checkups on a regular basis. 1 - Less True 2 3 4 5 - More True I have been successful in maintaining my ideal body weight. I am proud of my body. 1 - Less True 2 3 4 5 - More True An integral part of my leisure time includes physical activity instead of TV viewing or surfing the net. 1 - Less True 2 3 4 5 - More True I do not have any health conditions * 1 - Less True 2 3 4 5 - More True I recover well from illness. * 1 - Less True 2 3 4 5 - More True My self-esteem is not defined by my body image. * 1 - Less True 2 3 4 5 - More True I have a high level of self-confidence. * 1 - Less True 2 3 4 5 - More True I have a way to relax that eliminates stress and keeps me centered. * 1 - Less True 2 3 4 5 - More True I understand that I am more than what I do. * 1 - Less True 2 3 4 5 - More True I have been able to successfully handle stress more than usual lately. * 1 - Less True 2 3 4 5 - More True I feel my body and mind are in perfect harmony. * 1 - Less True 2 3 4 5 - More True I keep my mind alert by enrolling in courses, reading, and learning new things each day. * 1 - Less True 2 3 4 5 - More True I am happy and content with my spouse/partner, or happy being single. * 1 - Less True 2 3 4 5 - More True I feel encouraged when I meet someone that reflects what I want for myself. * 1 - Less True 2 3 4 5 - More True I know what my goals are and I am eagerly and effectively making them a reality. * 1 - Less True 2 3 4 5 - More True I call on a higher power in times of need. * 1 - Less True 2 3 4 5 - More True I feel that I am never too old to change. * 1 - Less True 2 3 4 5 - More True If I discovered that major changes were needed in my life, I would be more than willing to make them. * 1 - Less True 2 3 4 5 - More True I pay close attention to my health and well-being * 1 - Less True 2 3 4 5 - More True I am completely happy with the life I have created for myself. * 1 - Less True 2 3 4 5 - More True I am open to finding new ways to improve myself. 1 - Less True 2 3 4 5 - More True I feel a sense of accomplishment by helping others * 1 - Less True 2 3 4 5 - More True I am satisfied with accomplishing small tasks that contribute to a larger goal. * 1 - Less True 2 3 4 5 - More True I believe that my past experiences can help me reach my future goals. * 1 - Less True 2 3 4 5 - More True I get most of my strength from family, friends, or group support systems. * 1 - Less True 2 3 4 5 - More True I see coaching as a worthwhile investment in providing structure and support in reaching my goals. * 1 - Less True 2 3 4 5 - More True I can pay the coaching fee. * 1 - Less True 2 3 4 5 - More True I am willing to do the work and let the coach do the coaching. * 1 - Less True 2 3 4 5 - More True I feel that I would be interested in working with a coach in a group setting. * 1 - Less True 2 3 4 5 - More True I feel that I am interested in attending personal development workshops or seminars. 1 - Less True 2 3 4 5 - More True * Required
