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    Kirk Douglas Vitality Assessment

    Uploaded by

    rohishetty
    This document contains a vitality self-assessment with multiple categories to rate oneself in areas like eating right, exercise, managing stress, reducing toxic load, and informed self-care. The assessment uses a checklist format with statements to check off how often each applies, and asks the respondent to provide an overall self-rating in each category on a scale of 1-10.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Kirk Douglas Vitality Assessment

    Uploaded by

    rohishetty
    23 views3 pages
    This document contains a vitality self-assessment with multiple categories to rate oneself in areas like eating right, exercise, managing stress, reducing toxic load, and informed self-care. The assessment uses a checklist format with statements to check off how often each applies, and asks the respondent to provide an overall self-rating in each category on a scale of 1-10.

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    © © All Rights Reserved

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    This document contains a vitality self-assessment with multiple categories to rate oneself in areas like eating right, exercise, managing stress, reducing toxic load, and informed self-care. The assessment uses a checklist format with statements to check off how often each applies, and asks the respondent to provide an overall self-rating in each category on a scale of 1-10.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    23 views3 pages

    Kirk Douglas Vitality Assessment

    Uploaded by

    rohishetty
    This document contains a vitality self-assessment with multiple categories to rate oneself in areas like eating right, exercise, managing stress, reducing toxic load, and informed self-care. The assessment uses a checklist format with statements to check off how often each applies, and asks the respondent to provide an overall self-rating in each category on a scale of 1-10.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Vitality Assessment Name:

    Date:

    Rest & Reduce Informed


    Eat Right Exercise
    Manage Stress Toxic Load Self Care

    Place a check mark in the box for each answer that applies.
    Seldom Sometimes Always
    EAT RIGHT Never Me
    Me Me
    Often Me
    Me
    I experience a sense of well-being on a daily basis.

    I have adequate energy to “complete the work” of each day.

    I eat healthy, avoiding processed foods, and excessive consumption of stimulants.

    I have energy and vitality throughout the day.

    I eat an 80% plant-based diet, with at least 5 servings of fruits and vegetables daily.

    I have a positive relationship with food, and am rarely bothered by what I eat.

    I am free from food sensitivities.

    I take nutritional supplements regularly.

    I consume “clean” beverages, avoiding soda, energy, or other commercial drinks.

    I consume little to no alcohol.

    I am well hydrated with adequate daily water consumption for my body weight.

    I have a healthy gut. My digestion and elimination is rarely uncomfortable.

    Regardless of what I eat, I rarely experience heartburn, indigestion, gas, or bloating.

    Regardless of what I eat, I rarely experience constipation or diarrhea.

    I feel satisfied after I eat a reasonable meal, not continuing to crave food afterwards.

    My breath is tolerable.

    If I have children, they are consuming nutritional supplements regularly.


    Now, rate yourself overall in this area on a scale of 1-10
    (1 being the lowest, 10 being the highest)

    Seldom Sometimes Always


    EXERCISE Never Me
    Me Me
    Often Me
    Me
    I exercise regularly or am active for 30 mins. at least 5 days per week.

    I engage in strength and/or weight training at least 3 times a week.

    I live free of aches and pains.

    I move with ease throughout my day and during physical activity.

    I feel fit and have energy and endurance during physical activity.

    I breathe freely when physically active.

    I recover from physical activity quickly, with some energy remaining afterwards.

    I maintain my energy through the afternoon hours of each day.

    I use natural solutions to relieve occasional muscular discomfort due to activity.

    I am at my ideal weight.

    I maintain my weight with ease.

    My cravings and appetite are under control. I don’t under or over eat.

    Now, rate yourself overall in this area on a scale of 1-10


    (1 being the lowest, 10 being the highest)
    ©2021 Wellness Tools, LLC. All Rights Reserved.
    This information is the sole property of Wellness Tools, LLC,
    All trademarks are owned by dōTERRA® Holdings, LLC
    1
    and is not to be used in any way that is not authorized under the
    governing Terms of Service or expressly permitted in writing.
    Vitality Assessment
    Rest & Reduce Informed
    Eat Right Exercise
    Manage Stress Toxic Load Self Care

    Seldom Sometimes Always


    REST & MANAGE STRESS Never Me
    Me Me
    Often Me
    Me
    I fall asleep easily.

    I stay asleep throughout the night.

    My sleep is restful and satisfying and I awake feeling rested.

    I feel and act balanced emotionally.

    I handle stress with ease, and am rarely stressed out or anxious.

    I recover quickly from stressful situations.

    I maintain healthy, happy moods most of the time.

    I am rarely overwhelmed, am able to focus and concentrate, and get things done.

    I am free of excess worry or doubt, and am not prone to overthinking things.

    I am free of excess agitation or irritation and can adapt quickly to interruptions or changes.

    I am motivated and engage in the activities of my day with ease and enthusiasm.

    I experience passion for life and its activities on a consistent basis.

    I live with self-confidence and do not require excessive reassurance.

    I am trusting of myself and feel safe and capable to navigate or participate in most situations.
    Now, rate yourself overall in this area on a scale of 1-10
    (1 being the lowest, 10 being the highest)

    Seldom Sometimes Always


    REDUCE TOXIC LOAD Never Me
    Me Me
    Often Me
    Me
    I engage in routine internal body cleansing through diet, supplements, and programs.

    I use toxin-free products for my hair, skin, hand, and body care.

    I use toxin-free products for my face care and makeup.

    I use toxin-free products for my teeth/oral care.

    I use toxin-free products in my kitchen and to clean my home.

    I use toxin-free air purifying/freshening products.

    I use toxin-free laundry products.

    I use toxin-free products for my yard care.

    I eat primarily organic quality food.

    I use organic products to flavor my food.

    I experience healthy intestinal and urinary elimination throughout each day.

    I have clear skin on my face and body parts, free from breakouts.

    I am free from chemical or food sensitivities.

    My body aroma is favorable and I perspire in a healthy way.

    I drink pure or purified water.

    I have limited exposure to electromagnetic devices [cell phone, computer, TV, etc.].

    Now, rate yourself overall in this area on a scale of 1-10


    (1 being the lowest, 10 being the highest)

    ©2021 Wellness Tools, LLC. All Rights Reserved.


    2 This information is the sole property of Wellness Tools, LLC,
    All trademarks are owned by dōTERRA® Holdings, LLC
    and is not to be used in any way that is not authorized under the
    governing Terms of Service or expressly permitted in writing.
    Vitality Assessment
    Rest & Reduce Informed
    Eat Right Exercise
    Manage Stress Toxic Load Self Care

    Seldom Sometimes Always


    INFORMED SELF CARE Never Me
    Me Me
    Often Me
    Me
    I supplement daily with abundant sources of antioxidants for cellular health.

    I target my immune health as part of my daily supplement routine.

    I am prepared for life’s little emergencies and carry natural solutions on my person.

    I use toxin-free solutions when outdoors (e.g., sun, insects) and for first aid needs.

    I use targeted natural solutions/supplements for my body’s specialized needs.

    My Body Systems:

    I have a strong immune system and naturally resist getting sick.

    I am resilient and recover quickly from immune stress.

    I have strong muscular and skeletal systems.

    I have a healthy urinary system. My urine is a healthy color and aroma.

    I maintain healthy breathing throughout the seasons.

    I avoid smoking or vaping.

    My air quality is good [not regularly exposed to airborne toxins or excessive pollution].

    I have healthy hair, skin, and nails. My skin is clear, free from breakouts, spots, or dry patches.

    I have a strong nervous system.

    My decision-making and problem-solving capacities are high functioning.

    My mental focus, clarity, and memory are quick and sharp.

    I experience normal hearing and eyesight. I do not require aids or glasses.

    I have healthy circulation and maintain healthy body temperature in my extremeties.

    I maintain a normal body temperature, including during nighttime sleep.

    I have healthy reproduction, sex drive, and, for women, menstruation.

    I feel hormonally balanced. I stay even keeled throughout a monthly cycle.

    For men, I do not experience nighttime urination.


    Now, rate yourself overall in this area on a scale of 1-10
    (1 being the lowest, 10 being the highest)

    Proactive Medical Care Based on your answers above, identify your top health priorities.
    Healthcare
    20%

    Informed Self Care What do you want to experience more of?


    1.
    Reduce Toxic Load 2.
    3.
    Rest & Manage Stress
    Lifestyle
    80%

    What do you want to experience less of?


    Exercise
    1.
    2.
    Eat Right
    3.
    Record your ratings from each section.

    ©2021 Wellness Tools, LLC. All Rights Reserved.


    This information is the sole property of Wellness Tools, LLC,
    All trademarks are owned by dōTERRA® Holdings, LLC
    3
    and is not to be used in any way that is not authorized under the
    governing Terms of Service or expressly permitted in writing.

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