Lifestyle Medicine Vital Signs

Section

Questionnaire

With the scale questions below, please choose between 1-10 for each. 1 being the worst/least and 10 being the best/most.

Nourishment – Rate the quality of the food you put into your body on a daily basis:
Movement – Rate how often and for how long you move your body on a daily basis:
Connectedness – Rate how well you stay connected with family, friends and your higher power:
Sleep – Rate the quality of your sleep:
Positivity – Rate how often you engage in positivity enhancing practices:
(positive thinking, gratitude, avoiding negative self-talk, acts of kindness, forgiveness, mindfulness, meditation, prayer)
Resilience – Rate how well you are able to manage stress in your life:
Green and Blue – Rate how often and how long you spend in nature or outdoors:
Screen time – Rate how happy you are with your current amount of screen time:
Substance use – Rate how comfortable you are with any current substance use:
(smoking, alcohol, drugs)
Purpose – Rate how well you feel you are fulfilling your passion, purpose or vocation in life: