Congratulations on your decision to take charge of your health and well-being! This sheet will give you a great way to track the progress you are making, with weight-loss, as well as general health. Take a moment to fill this out, and take a front and side view picture of yourself. Try to wear the same clothes each time so you can really see the physical differences. Fill this out once each month so you can look back and see the improvements you’ve made!
Measurements
Bust: __________
Chest: __________
Waist: __________
Hips: __________
Thigh: __________
Upper arm: __________
Neck: __________
Total of all measurements: ___________
Weight: ___________
Pants size: ___________
Shirt size: ___________
Body Fat Percentage: ___________
Overall health/well-being
How well do you sleep at night?
Poorly Sleep
straight through
1 2 3 4 5 6 7 8 9 10
How is your overall mood?
Tend to be moody Positive,
upbeat!
1 2 3 4 5 6 7 8 9 10
Do you have body aches and pains?
Lots of aches and
pains Pain-free
1 2 3 4 5 6 7 8 9 10
Do you suffer from migraines or frequent
headaches?
Daily Once/week Rarely
1 2 3 4 5 6 7 8 9 10
How much energy do you have in the morning?
Where’s my
coffee??!! Ready
to take on the world!
1 2 3 4 5 6 7 8 9 10
How much energy do you have in the afternoon?
Time for a nap!! Time
for a run!
1 2 3 4 5 6 7 8 9 10
How regular are you?
Constipated and/or
Sudden bouts of
diarrhea Very
regular, not constipated
1 2 3 4 5 6 7 8 9 10
For Women:
How severe are your PMS symptoms?
Hormone alert!!! Even
keel all month
1 2 3 4 5 6 7 8 9 10
Describe your usual diet as of
today, including frequent cravings or “weaknesses”:
Notes, thoughts on how you’re
feeling in general: