In the past week, please rate how true each of the following statements is to you on

0 = Not true at all

1 = Not very true
2 = Somewhat true
3 = Very true
4 = Extremely true

Sleep
It’s easy for me to fall asleep.
I stay asleep through the night.
I feel like I get enough quality sleep.
Even when my sleep is not optimal, I still have plenty of energy to get through the day.
When I wake up, I feel rested, alert, and energized.
Sleep Subtotal
Hunger
I easily last 5-6 hours without going hungry.
I wake up feeling full and comfortably satisfied.
My stomach feels comfortable and calm between meals.
When I eat, I become full quickly and feel satisfied long after.
My hunger is predictable and stable form hour-to-hour and day-to-day.
Hunger Subtotal
Mood
My mood is stable all day long and remains the same from morning, through afternoon and into th
I’m laid back and relaxed without worry or anxiety.
I return to a happy feeling very quickly after stressful, depressing or hurtful events.
From one day to the next, my mood is predictable and essentially the same.
My mood remains calm and in control despite what’s going on around me (sights, sounds, tempera
Mood Subtotal
Energy
My energy is stable throughout the day and from one day to the next.
If I get exhausted, I rebound quickly and my energy returns to normal fast.
I always have the energy I need to do what I want.
I enjoy the energy I need without turning to food or caffeinated drinks.
I’m easily motivated, stay focused and get things done.
Energy Subtotal
Cravings
I stop eating once I’m full (or have satisfied a craving) with no problems.
I go all day without experiencing cravings.
I handle stress without craving certain foods.
My thoughts about food come and go and I don’t obsess about anything in particular.
I rarely feel the desire for sweets or alcohol after I have already eaten.
Cravings Subtotal

DO NOT ENTER ANYTHING IN THE FIELDS BELOW

Grand Total
# Difference to Day 1
% Difference to Day 1
4 where:

IMPORTANT: Take your first measurements the morning you start, then weekly for the remainde

Beginning Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS

- - - - - - - - -
N/A - - - - - - - -
N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
ly for the remainder of the program. Do your program finish measurements at the end of week 12.

Week 9 Week 10 Week 11 Week 12

0 0 0 0

0 0 0 0

0 0 0 0
 0 0 0 0

0 0 0 0

- - - -
- - - -
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
nd of week 12.
In the past week, please rate each area as follows

0 = Never or almost never have the symptom

1 = Occasionally have it, effect is not severe
2 = Occasionally have it, effect is severe
3 = Frequently have it, effect is not severe
4 = Frequently have it, effect is severe IMPORTANT: Take your fi

Health Area Beginning

Bad Odors
Underarms
Breathe
Feet
Crotch
Gas
Subtotal 0

Body Heat/Sweating
Sweaty palms or feet
Sweat easily/excessive sweating
Cold sweats often
Night sweats
Easily chilled
Low tolerance to cold weather
Extremities get cold easily (especially hands and feet)
Hot flashes
Subtotal 0

Face
Large pore size
Wrinkles/fine lines
Puffiness
Oily
Dry
Rosacea/flushed
 Subtotal 0

Skin
Discolored/purple
Acne/pimples/eczema
Itching
Scaly/dryness/roughness/ cracking/ psoriasis
Looseness/Flappiness
Bruise easily
Skin tags/Cysts
Brown/sun spots
Hives/rashes
Sores
Cellulite/dimples/saggy shadows
Stretch marks
Poor muscle tone
Varicose veins
Numbness
Tingling
Searing pain
Subtotal 0

Mental
Difficulty concentrating or focusing
Trouble remembering things/forgetfulness
Tend to procrastinate
Brain fog/slow thinking
Lack of attention to detail
Trouble delaying what you want/needs instant gratification
Trouble listening
Problems getting organized
Restless/hyperactive
Difficulty making decisions
Stuttering/stammering
Slurred speech
Confusion, poor comprehension
Poor physical coordination
Subtotal 0

Mood
Anger/irritability
Agitated/restless
Anxiety/stress/worry
Short tempered/short fuse
Emotional outbursts
Sadness/depression
Negative thinking
Low interest in things normally pleasurable
Mood swings/unstable mood
Low self-esteem/lack of confidence/worthlessness
Lack of desire to socialize
Lack of feeling anything/apathy
Subtotal 0

Energy
Exhausted/fatigued/sluggish
Apathy/lethargy
Lack of motivation to exercise
Energy crashes/drowsy in mid- to late afternoon
Drawn to caffeine, sugar/sweets or carbs for energy
Low energy or drowsy after meals
Subtotal 0

Sleep
Trouble getting to sleep
Trouble staying asleep
Don't get enough sleep
Wake up feeling tired
Sleep not restful
Excessive snoring or sleep apnea
Wake up between 2 a.m. - 4 a.m. for 15 minutes or longer
Subtotal 0
Joints and Muscles
Aches/pains/soreness
Stiffness
Mobility/flexibility
Arthritis
Limitation of movement
General feeling of weakness/lack of strength
Subtotal 0

Cravings
Sugar/sweets
Simple carbs such as bread, pasta
Fatty Foods
Salty foods
Dairy (milk, ice cream, yogurt, cheese, etc.)
Alcohol
Coffee
Drugs
Subtotal 0

Hunger/Appetite
Get agitated or angry between meals
Can't go more than 3 hours without eating
Lightheaded if meals are missed
Eating relieves fatigue
Eat to relieve depression or sadness
Skip meals often
Eat late at night or before bed
Wake up in middle of night hungry
Frequently binge eat
Trouble stopping eating even when full
Need to snack often
Compulsive eating
Subtotal 0
Digestion
Passing gas
Burping
Bloating
Stomach/abdominal pain
Acid reflux
Heartburn/GERD
Cramping
Nausea/upset stomach
IBS
Subtotal 0

Hair
Hair loss
Dryness
Thinning
Dandruff/flaky scalp
Dry scalp
Itchy scalp
Red scalp
Subtotal 0

Head
Headaches/migraines
Faintness
General Dizziness
Lightheaded, especially when getting up
Shaky
Subtotal 0

Nose
Trouble breathing
Runny nose
Stuffy nose
Post nasal drip
Sinus problems
Hay fever
Sneezing attacks
Excessive mucus formation
Subtotal 0

Ears
Itchy ears
Earaches/ear infections
Drainage
Trouble hearing
Ear pressure
Ringing/tinnitus
Subtotal 0

Eyes
Watery or itchy eyes
Swollen, reddened, or sticky eyelids
Burning sensation
Muscle twitching around eyes
Bags or dark circles under eyes
Blurred or tunnel vision (does not include near-or far-sightedness)
Sensitive to light
Impaired night vision
Subtotal 0

Nails
Weak
Cracked or split
Ridged/rippled
Puffy nail fold
Gnawed nails
Yellowish/whitish/bluish/pale color
Subtotal 0

Mouth/Throat
Soreness
Itchiness
Chronic coughing
Difficulty swallowing
Gagging reflex
Frequent need to clear throat
Hoarseness, or loss of voice
Swollen or discolored tongue, gum, or lips
Canker sores
Overall sense of taste
Dry mouth
Frequent thirst
Subtotal 0

Lungs
Shortness of breath
Labored/difficult breathing
Asthma/bronchitis
Sneezing attacks
Wheezing when breathing
Congestion
Subtotal 0

Heart
Irregular or skipped heartbeat
Rapid or pounding heartbeat
Heart palpitations/racing heart
Chest pain
Fast pulse rate at rest
Pulse increases after eating
Rapid pulse before bed
Subtotal 0

Elimination
Frequent urination
Pain urinating
Urgent urination
Wake frequently to urinate
Stool unusual in color, shape or consistency
Hard stool
Foul-smelling stool
Diarrhea
Constipation
Subtotal 0

Other
Genital itching/discharge
Tender lymph nodes
Sore breasts
Loss of breast fullness
Vaginal dryness
Itchy or stinging anus
Irregular periods
Bad PMS symptoms
Recurring yeast infections
Chronic fungus on nails, skin or athlete's foot
Lack of sex drive
Frequently ill or get colds, flu, viruses, etc.
Subtotal 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMAT

Grand Total -
# Difference to Day 1 N/A
% Difference to Day 1 N/A
PORTANT: Take your first measurements the Sunday before start, then weekly on every Sunday on throug

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS

- - - - - - - - -
- - - - - - - - -
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
ery Sunday on through to your final measurements at the END of week 12.

Week 10 Week 11 Week 12

0 0 0

0 0 0
0 0 0

0 0 0
0 0 0

0 0 0

0 0 0

0 0 0
0 0 0

0 0 0

0 0 0
0 0 0

0 0 0

0 0 0
0 0 0

0 0 0

0 0 0

0 0 0
0 0 0

0 0 0

0 0 0
 0 0 0

0 0 0

- - -
- - -
#DIV/0! #DIV/0! #DIV/0!
In the past week, here is how you rated the most common PMS symptoms. Note, the

IMPORTANT: You do not need to fill anything in here. This is au

Beginning Week 1 Week 2 Week 3
Abdominal bloating 0 0 0 0
Abdominal pain 0 0 0 0
Sore breasts 0 0 0 0
Acne 0 0 0 0
Food cravings, especially for sweet 0 0 0 0
Constipation 0 0 0 0
Diarrhea 0 0 0 0
Headaches 0 0 0 0
Sensitivity to light or sound 0 0 0 0
Fatigue 0 0 0 0
Irritability 0 0 0 0
Changes in sleep patterns 0 0 0 0
Anxiety 0 0 0 0
Depression 0 0 0 0
Sadness 0 0 0 0
Emotional outbursts 0 0 0 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMAT

Total - - - -
# Difference to Day 1 N/A - - -
% Difference to Day 1 N/A #DIV/0! #DIV/0! #DIV/0!
MS symptoms. Note, these scores have been auto-populated and totaled based on your respo

l anything in here. This is auto-populated from your Health Tracker

Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0

W -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS

- - - - - - - -
- - - - - - - -
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
ed on your responses to the Health Tracker.

Week 12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

-
-
#DIV/0!
In the past week, here is how you rated the most common menopause symptoms. N

IMPORTANT: You do not need to fill anything in here. T

Beginning Week 1 Week 2 Week 3
Irregular periods 0 0 0 0
Vaginal dryness 0 0 0 0
Hot flashes 0 0 0 0
Night sweats 0 0 0 0
Sleep problems 0 0 0 0
Mood changes 0 0 0 0
Thinning hair 0 0 0 0
Dry skin 0 0 0 0
Loss of breast fullness 0 0 0 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOM

Total - - - -
# Difference to Day 1 N/A - - -
% Difference to Day 1 N/A #DIV/0! #DIV/0! #DIV/0!
use symptoms. Note, these scores have been auto-populated and totaled based on your resp

ll anything in here. This is auto-populated from your Health Tracker

Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0

- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS

- - - - - - - -
- - - - - - - -
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
sed on your responses to the Health Tracker.

Week 12
0
0
0
0
0
0
0
0
0

-
-
#DIV/0!
INSTRUCTIONS: Enter your measurement in inches below

Beginning Week 1 Week 2 Week 3 Week 4

Hips
Lower abs
Waist
Bust
R. Thigh
L. Thigh
R. Calf
L. Calf
R. Upper Arm
L. Upper Arm
R. Forearm
L. Forearm
Neck

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY C

Total - - - - -
# Difference to Day 1 N/A - - - -
% Difference to Day 1 N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Apple point (waist to bust ratio) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Pear point (waist to hip ratio) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Remember, the closer the apple point and pear point are to 0.7, the closer you are to the perfect
 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week12

WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS

- - - - - - - -
- - - - - - - -
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

r you are to the perfect hourglass shape.

INSTRUCTIONS: Enter your weight below and your height to the right-- BMI will automatically ca

Beginning Week 1 Week 2 Week 3 Week 4 Week 5

Weight (enter here)
BMI (don't enter) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AU

# Difference to Day 1 N/A - - - - -
% Difference to Day 1 N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
MI will automatically calculate

Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

ELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS

- - - - - - -
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Height (in inches) <== Put your height in inches here