HOW DO I FEEL TODAY?

…Want To Get The Most Out Of Your Shaklee Supplement Program?...

Before You Begin Using Or Adding Supplements:

• Rate yourself on a scale of 1-10 in each category below.
After: 7 Days - 14 Days - 21 Days - 30 Days - 60 Days - 90 Days
• Rate yourself again to see and feel the differences only you
would notice.

Please note:
This questionnaire is not intended to judge, diagnose, treat, cure, or
prevent any disease. This is simply a way to get a baseline and then
track your progress. To get the best results - be honest with yourself.

KEY: 1 would be Low, Bad, Not at all … 10 would

be High, Great, Yes!

How do I feel before I get out of bed? 1

1 … 5 … 0
How do I feel at 3:00 in the afternoon? 1
1 … 5 … 0
How do I feel when I go up or down stairs? 1
1 … 5 … 0
How are my focus and my ability to concentrate? 1
1 … 5 … 0
How’s my mental attitude, moods? 1
1 … 5 … 0
How do I feel a little while after eating? 1
1 … 5 … 0
How’s my intake of vegetables, healthy protein vs 1
intake of sugars, breads, snacks, fast food? 1 … 5 … 0
Add your own areas where you’d like to see improvements:
1
1 … 5 … 0
1
1 … 5 … 0
1
1 … 5 … 0
Source: ©2009 Mark Alan
Adapted: Maryann Wilshere (11.2009)