Get Your Wellness Scorecard
  • Step 1
  • Step 2
  • Step 3
  • Step 4
  • Step 5
  • Step 6

Step 1: General Health

Male Female

Step 2: Healthy Choices

When you feel something is not right
Annually as a preventative measure
Never
Only when you are really sick
Yes Occasionally No
0 1-2 3-4 More than 4
0 1-2 3-5 More than 5
I drink at least 8 glasses of water each day
I average about five to six glasses on most days but I sometimes get eight.
I don't drink much water.
Less than 5 5-6 6-7 7-9 More than 9
Yes No Occasionally

Step 3: Healthy Diet

I don't eat many whole grains. It's mostly white bread, white pasta and any breakfast cereal that's easy.
I generally eat two or three servings of whole grains like whole-grain bread, oatmeal, other cereals labeled "whole grain" or wild/brown rice each day.
I easily eat more than three servings of whole grains like whole-grain bread, oatmeal, other cereals labeled "whole grain" or wild/brown rice each day.
I don't like vegetables but I eat a few because I know its good for me.
I generally eat about two cups of vegetables each day but not always the dark green vegetables like I should.
I love vegetables and easily eat 2 cups each day. I also try to get a couple of servings of dark green vegetables like broccoli or spinach each week.
I eat at least 2 pieces (or cups) of fruit each day and I try to keep my juice intake to less than half of my total fruit each day.
I generally have one piece (or cup) of fruit each day but I tend to drink more fruit juice than actual fruit.
I'll have a piece of fruit every once in a while, but it's not my favorite
I eat about 6 ounces of lean protein like lean meat, chicken without the skin, fish, beans or tofu each day.
I probably eat more than 6 ounces of lean protein like lean meat, chicken without the skin, fish, beans or tofu each day.
I eat as much protein as I like each day; and I tend to like fatty meats; cold cuts; sausage as well as dark meat chicken, skin and all.
I rarely or never consume dairy products
I choose only regular milk and/or full fat items in the dairy category.
I probably have 1 or 2 cups of fat-free or low-fat (1%) milk, yogurt or cottage cheese each day.
I have 3 cups of fat-free or low-fat (1%) milk, yogurt or cottage cheese each day.
I don't like seafood
I try to eat seafood, especially oily fish like salmon, once a week.
I love seafood and try to eat oily fish, like salmon, at least twice a week.
Each week I eat at least 3 cups of beans, peas, lentils or split peas in salads,chili, soups.
Each week I try to eat some beans, peas, lentils in salads, chili, soups.
I don't think about whether I eat beans, peas, lentils or split peas
I watch my intake of added oils from salad dressing, sauces and cooking (no more than 2 oz a day) and I use vegetable oils like olive or canola whenever possible .
I try to watch my intake of added oils in salad dressing and sauces, but I'm not really sure how much it is. I know I use vegetable oils like olive or canola whenever possible .
I don't pay attention to the type or the amount of added oils I eat every day.
I don't track how much fiber I eat.
I try to eat foods with more fiber each day.
I try to eat at least 32 grams of fiber each day.
I limit the salt I use in cooking, and I read food labels carefully to limit other sources of salt and sodium whenever I can.
I try to limit the salt I use in cooking, and I sometimes read food labels to limit other sources of salt and sodium when I remember.
I always use salt in cooking, and I don't think about how much salt or sodium I consume.
I choose and prepare foods and beverages with little added sugar or caloric sweeteners
When I remember, I try to choose and prepare foods and beverages with little added sugar or caloric sweeteners. .
I eat a lot of sugary foods and drink quite a few sugary beverages..
I eat a lot of processed foods like chips and frozen dinners daily
I know I eat too much fatty food like red meat and cream cheese, but that's what I like to eat
I know cholesterol-rich foods like eggs, cheese and dark meat poultry should be eaten in moderation, but I tend to eat them several times a day.
I do a fairly good job of avoiding processed foods. I watch what I eat when it comes to cholesterol rich dishes and I try to avoid fatty foods like whole milk and fatty meat.

Step 4: Supplements

Yes No
Daily Several times a week When I feel the need I don't take one
With food On an empty stomach I don't take one
Yes No
None
 
Vitamin A
Vitamin B/B Complex
 
Vitamin C
Vitamin D
 
Vitamin E
Calcium
 
Magnesium
Zinc
 
Echinacea
Garlic
 
Ginkgo Biloba
Ginseng
 
Green Tea
Saw Palmetto
 
St. John's Wort
Valerian
 
Coenzyme Q10
Glucosamine + Chondroitin
 
Lutein
Lycopene
 
Fish Oil
Flax Seed/Oil
 
Sports Nutrition Supplements
General health
 
Particular condition
Energy
 
Weight management
To increase muscle mass
 
To augment diet
To supplement a poor/marginal diet
 
Because I think it's the smart thing to do
I don't take supplements
 
Doctor
 
Nurse
Pharmacist
 
Dietitian/ Nutritionist
Salesperson
 
Family
Friends
 
Internet
TV, Radio, Newspapers, Magazines
 
Nowhere

Step 5: Exercise

I don't have one
I try to exercise 2 - 3 times per week
I exercise at least 4 to 5 times per week and sometimes more
I exercise for at least an hour every day
No exercise 30 minutes 1 hour 2 hours
No exercise
I enjoy cardiovascular exercise like running, walking, aerobics, dancing, tennis or basketball
I enjoy recreational activities like golfing, softball, fishing or camping
I enjoy lifting weights and other strength training activities
My day is not complete without a yoga or pilates class
I try to work out on a regular basis, but life and work often prevent me from exercising like I should
I stick to the same routine because it works for me
I like to change my exercise routine on a regular basis just to keep it interesting
I change my workout on a regular basis in order to improve my performance
Nothing
I take the stairs instead of the elevator at work
I park away from the grocery store and the mall to increase my walking
I walk around the office a lot instead of using e-mail
I try to stay active around the house and in the yard, especially on weekends