"Personal Progress Chart Template"

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How Do You Feel Today?
How Do You Feel Today?
A Personal Progress Chart
We tend to forget health problems that bothered us when they are gone. Use this chart to take inventory of how you feel as you
begin a change and note your progress in 30, 60 and 90 days. Rate each condition in terms of frequency and/or intensity on a
scale of 1 to 5 (1 being the best, 5 being worst). Your Name _______________________________
Today
Condition
30 Days 60 Days 90 Days
1 ______ Low energy/ Often feel tired
1
______
______
______
2. ______ Overweight or underweight
2
______
______
______
3. ______ Skin problems – dry, itchy, acne, etc.
3
______
______
______
4. ______ Headaches or migraines
4
______
______
______
5. ______ Aching joints or arthritis
5
______
______
______
6. ______ Diabetes or low blood sugar levels
6
______
______
______
7. ______ Back Ache, Joints
7
______
______
______
8. ______ Subject to colds and/or infections
8
______
______
______
9. ______ High or low blood pressure
9
______
______
______
10. ______ Depression
10 ______
______
______
11. ______ Cold hands and/or feet
11 ______
______
______
12. ______ Difficulty handling stress
12 ______
______
______
13. ______ Poor concentration, memory lapses
13 ______
______
______
14. ______ Allergies
14 ______
______
______
15. ______ Difficulty falling asleep or waking up
15 ______
______
______
16. ______ Digestive problems, heartburn, ulcers, etc
16 ______
______
______
17. ______ Constipation
17 ______
______
______
18. ______ Mouth problems – gums, teeth, bad breath
18 ______
______
______
19. ______ Hair problems – thinning, graying, dull
19 ______
______
______
20. ______ Eye problems
20 ______
______
______
21. ______ Varicose veins
21 ______
______
______
22. ______ Hemorrhoids
22 ______
______
______
23. ______ Asthma, shortness of breath
23 ______
______
______
24. ______ Heart and or circulatory problem
24 ______
______
______
25. ______ Take aspirin or pain pills often
25 ______
______
______
26. ______ Addictions – smoking, coffee, alcohol, drugs
26 ______
______
______
27. ______ Hearing problems
27 ______
______
______
28. ______ Immune system problems
28 ______
______
______
29. ______ Cuts and/or bruises heal slowly
29 ______
______
______
30. ______ Water retention, bloating
30 ______
______
______
31. ______ Lack of strength, weakness
31 ______
______
______
32. ______ UTI, Incontinence
32 ______
______
______
33. ______ Menstrual cramps/ Moodiness/ PMS
33 ______
______
______
34. ______ Tremors
34 ______
______
______
35. ______ ____________________________________
35 ______
______
______
36. ______ ____________________________________
36 ______
______
______
37. ______ ____________________________________
37 ______
______
______
38. ______ ____________________________________
38 ______
______
______
How Do You Feel Today?
How Do You Feel Today?
A Personal Progress Chart
We tend to forget health problems that bothered us when they are gone. Use this chart to take inventory of how you feel as you
begin a change and note your progress in 30, 60 and 90 days. Rate each condition in terms of frequency and/or intensity on a
scale of 1 to 5 (1 being the best, 5 being worst). Your Name _______________________________
Today
Condition
30 Days 60 Days 90 Days
1 ______ Low energy/ Often feel tired
1
______
______
______
2. ______ Overweight or underweight
2
______
______
______
3. ______ Skin problems – dry, itchy, acne, etc.
3
______
______
______
4. ______ Headaches or migraines
4
______
______
______
5. ______ Aching joints or arthritis
5
______
______
______
6. ______ Diabetes or low blood sugar levels
6
______
______
______
7. ______ Back Ache, Joints
7
______
______
______
8. ______ Subject to colds and/or infections
8
______
______
______
9. ______ High or low blood pressure
9
______
______
______
10. ______ Depression
10 ______
______
______
11. ______ Cold hands and/or feet
11 ______
______
______
12. ______ Difficulty handling stress
12 ______
______
______
13. ______ Poor concentration, memory lapses
13 ______
______
______
14. ______ Allergies
14 ______
______
______
15. ______ Difficulty falling asleep or waking up
15 ______
______
______
16. ______ Digestive problems, heartburn, ulcers, etc
16 ______
______
______
17. ______ Constipation
17 ______
______
______
18. ______ Mouth problems – gums, teeth, bad breath
18 ______
______
______
19. ______ Hair problems – thinning, graying, dull
19 ______
______
______
20. ______ Eye problems
20 ______
______
______
21. ______ Varicose veins
21 ______
______
______
22. ______ Hemorrhoids
22 ______
______
______
23. ______ Asthma, shortness of breath
23 ______
______
______
24. ______ Heart and or circulatory problem
24 ______
______
______
25. ______ Take aspirin or pain pills often
25 ______
______
______
26. ______ Addictions – smoking, coffee, alcohol, drugs
26 ______
______
______
27. ______ Hearing problems
27 ______
______
______
28. ______ Immune system problems
28 ______
______
______
29. ______ Cuts and/or bruises heal slowly
29 ______
______
______
30. ______ Water retention, bloating
30 ______
______
______
31. ______ Lack of strength, weakness
31 ______
______
______
32. ______ UTI, Incontinence
32 ______
______
______
33. ______ Menstrual cramps/ Moodiness/ PMS
33 ______
______
______
34. ______ Tremors
34 ______
______
______
35. ______ ____________________________________
35 ______
______
______
36. ______ ____________________________________
36 ______
______
______
37. ______ ____________________________________
37 ______
______
______
38. ______ ____________________________________
38 ______
______
______