Section 1: Physical Body
1. I wake up feeling rested and ready for the day.
Never
Rarely
Sometimes
Often
Always
2. I maintain steady energy throughout the day without relying on caffeine or sugar.
Never
Rarely
Sometimes
Often
Always
3. I engage in regular movement/exercise that leaves me feeling good, not depleted.
Never
Rarely
Sometimes
Often
Always
4. My body feels comfortable and free of persistent aches, pains, or tension.
Never
Rarely
Sometimes
Often
Always
Section 2: Biochemical Body
5. My digestion feels smooth—I rarely experience bloating, IBS, or heartburn.
Never
Rarely
Sometimes
Often
Always
6. My weight feels stable and aligned with where I want it to be.
Never
Rarely
Sometimes
Often
Always
7. My menstrual cycle / hormonal health feels balanced and manageable.
Never
Rarely
Sometimes
Often
Always
8. My skin, hair, and nails reflect good internal health (clear, strong, healthy).
Never
Rarely
Sometimes
Often
Always
Section 3: Psycho-Emotional Body
9. I feel emotionally resilient and able to handle stress well.
Never
Rarely
Sometimes
Often
Always
10. I maintain good focus and mental clarity without brain fog.
Never
Rarely
Sometimes
Often
Always
11. I feel connected to my authentic self, rather than just “going through the motions.”
Never
Rarely
Sometimes
Often
Always
12. I feel hopeful, motivated, and excited about my future.
Never
Rarely
Sometimes
Often
Always
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