A F RES H ST AR

T
Lifestyle Assessment Questionnaire

Adapted from

Dr. Andy Ng’s

“FRESH START”
 “I … Pray…”

I always pray that God will use the information

contained in this Health Program to:
Help those who read it, and that they will take
the information contained in the Health
Program and-
Use it to help the reader and their family
experience an improved life & better health.
 A FRESH START
A

F
R
E
S
T
TH
R SSRunlight
emperance
rustAood
est
inir God
ydration
AF ervice
elationships
E parrel
xercise
H

S
T
A
R
T
 A FRESH START
Clean/modest A parrel
Whole, plant based, organic F ood
Meaningful R elationships
Vigorous E xercise
Responsible S ervice
Substantial H ydration
Adequate S unlight
Sensible T emperance
Abundant A ir
Commitment to R est
A profound T rust in God

Adapted from Dr. Andy Ng’s Mnemonic FRESH START

Appar
Good Food
Relationships
Exercise
Hydration
Sunlight

Mervyn G. Hardinge, MD
Temperance:
Moderation
Abstemiousness
Pure Air
Rest
Trust in divine power
Lifestyle Assessment Questionnaire
Lifestyle Questionnaire
Name __________________________________________ Phone# _______________________
Address ______________________________________________________ Zip ____________
eMail ______________________________ M__ F__ Age ____ Height _____ Weight ______
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A Instructions:
Instructions: Having to do with past year---please circle 0 to 3 for your intensity.
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
12. Uses mustard or vinegar regularly …………………………… 0 1 2 3
A. Apparel – Wearing your badge of morality
13. Sunburns ……………………………………………………….. 0 1 2 3
14. Takes recreational drugs ………..…………………………….. 0 1 2 3
Women:
15. Takes prescribed medications ………………………………… 0 1 2 3
1. Hair long, hanging onto shoulders, straggly………………………………………….. 0 1 2 3
16. Uses fluoride toothpaste ……………………………………….. 0 1 2 3
2. Tops with low cut neck line ……..…....................................................................... 0 1 2 3
F 3. Blouses made of shear ‘see through’ material .………………………………………
4. Skirts short and/or split in leg …………….……………………………………………..
17.
18.
Has amalgam fillings in teeth …………………………………. 0 1 2 3
0 1 2 3
Uses aluminum cookware ……………………………………… 0 1 2 3
0 1 2 3
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Shoes with high heels or ‘spiked’ heels .…..…………………………………………. D. 0 1 Rest 2 3 of Body and Mind – Build up Time

R Men: 2.
1.

1. Ties are ‘loud’ colors ..................................…..……………………………………….

Gets no sleep before midnight …………………….…………… 0 1 2 3
Goes to bed at different time every night ………....…………... 0 1 2 3
3. Sleeps in a room with a light0or 1 2 3 on ….…….………... 0 1 2 3
television
2. Shirts with gaudy printed patterned shirts ……………………………………………. 0 1 2 3
E
4. Has a pessimistic attitude ………………………………………. 0 1 2 3
3. Wears shorts ……..................................................................................................
5. Has snacks between meals 0 …………………………….………..
1 2 3 0 1 2 3
4. Shoes are ‘showy’…………………………………………………………………………... 6. 0 1
Always seems to be in a rush …………………………………… 0 1 2 32 3
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
B. Food – Proper Fuel for an Optimal Diet
S
 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
E. Exercise – Stimulus for Life’s Functions
1. 
NeglectsG. to get regular Water – The …………………………………….
exercise Best Solvent 0 1 2 3
1. Has irregular mealtimes ……………………………………………………………….. 2.  1. Uses 0
unfiltered
Gets rest or sleep after meals ………………………………………. 1 2 3water for drinking …………………………….
city 0 1 2 3 0 1 2 3
2. Drinks with meals ……………………………………………………………………….. 3.  2. Bathes in 0 1 2
chlorinated 3 city
Does hard mental or physical work after eating ………………….. 0 1 2 3 water …………………………………… 0 1 2 3

H 3. Eats between meals ……………………………………………………………………..

4. Has heavy meal in evening …………………………………………………………….
4. 


Neglects3.opportunity of
4.
5.
Does
breaking
Neglects to
Drinks less
0 a sweat
not change 1 2garments
0 take
1 2cold
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Eats when excited, anxious, in a hurry, or angry ………………………………….. 0 than
3
every regularly
day ……………...……………………………….
0 1 2 3
3 showers or steam baths ……………………. 0 1 2 3
1 2 quarts
3
F. (8 cups) of water
Nutrition daily …………………
– Proper Fuel
0 1 2 3

0 1 2 3
6. Does not chew food thoroughly ………………………………………………………. 1.  Has irregular 0 1 2 3
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
mealtimes …………………………………………… 0 1 2 3
7. Eats salty foods (chips, pretzels, soy sauce) ………………………………………… 2.  DrinksH. with meals Trust 0 1 Power
in Divine
………………………………………………….. 2 3 – God Cares 0 1 2 3
8. Has diet of mostly cooked foods ……………………………………………………… 3.  1.
Eats between mealsHas 0 1 attitude
unthankful
………………………………………………… 2 3 …………………………………………… 0 1 2 3 … 0 1 2 3
9. Eats margarine regularly ……………………………………………………………….  2. Does not 0 1troubles
take 2 3 to God …………………………………….. 0 1 2 3

S
4. Has heavy meal in evening ………………………………………… 0 1 2 3
10. Eats white bread, white rice, white sugar ……………………………………………
5. 
Eats when3. excited, anxious, Is chronic in a0 1 2or
worrier
hurry, 3angry ………………… 0 1 2 3
…………………………………………………..,,,, 0 1 2 3
11. Eats flesh foods daily (meat, fish, foul) ………… 6. ……………………………………

Does not4. chew food thoroughly
Neglects to 0 …………………………………….
1 2
read Bible3 daily ……………………………………….. 0 1 2 3 .. 0 1 2 3
12. Eats fried or oily foods daily . ………………………………………………………….. 5. salty foods Neglects to0 witness
2 3to others
1 pretzels, ………………………………………. 0 1 2 3

T

7. Regularly eats (chips, nuts, soy sauce) ……... 0 1 2 3
8. 
Has diet ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
of mostly cooked foods …………………………………… 0 1 2 3
9.  EatsFinished?
margarinePlease regularlyreserve this comment area for your Preventive
………………………………………….. 0 1 2Care
3 Practitioner. Thank
you.

A
10. Eats white bread, white rice, white sugar ………………………… 0 1 2 3
 Comments
11. Eats flesh foods daily (meat, fish, foul) …………………………… 0 1 2 3
 Preventive Care Practitioner
12. Eats fried or oily foods daily ………………………………………. 0 1 2 3
 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

R
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
 True Remedies
 Pure air, sunlight, abstemiousness, rest, exercise, proper diet, the use of water, trust in
divine power,--these are the true remedies. Every person should have a knowledge of

T nature's remedial agencies and how to apply them. Ministry of Healing, by Ellen G. White,
Review and Herald, 1905, page 127
 Time to Do the Questionnaire
A
Instructions:

F Having to do with past year---please circle 0 to 3 for

R your intensity.
E
S 0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
H

0 1 2 3
S
0 1 2 3
T
0 1 2 3
A
0 1 2 3
R
0 1 2 3
T
 Lifestyle Assessment Questionnaire

A
Name __________________________ Phone# _______________________

F
Address _______________________________________ Zip ____________
R
E eMail ________________ M__ F__ Age ____ Height _____ Weight ______

S
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
H Instructions:

S Having to do with past year---please circle 0 to 3 for your intensity.

T
A 0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
R
T
 Apparel
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A
A. Apparel – Wearing your badge of morality
F
Women:
R 1. Hair long, hanging onto shoulders, straggly………. 0 1 2 3
E 2. Tops with low cut neck line ……..….......................... 0 1 2 3
S 3. Blouses made of shear ‘see through’ material .….. 0 1 2 3
4. Skirts short and/or split in leg …………….………… 0 1 2 3
H 0 1 2 3
5. Shoes with high heels or ‘spiked’ heels .…..………

S Men:
T 1. Ties are ‘loud’ colors ..................................…..……. 0 1 2 3
A 2. Shirts with gaudy printed patterned shirts ……….. 0 1 2 3
R 3. Wears shorts ……..................................................... 0 1 2 3
T 4. Shoes are ‘showy’……………………………………… 0 1 2 3
 Food
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A B. Vegetarian Food – Proper Fuel for an Optimal Diet

1. Has irregular mealtimes …………………………… 0 1 2 3

F
2. Drinks with meals …………………………………… 0 1 2 3
R 0 1 2 3
3. Eats between meals …………………………………
E 0 1 2 3
4. Has heavy meal in evening …………………………
S 0 1 2 3
5. Eats when excited, anxious, in a hurry, or angry
0 1 2 3
H 6. Does not chew food thoroughly …………………. 0 1 2 3
7. Eats salty foods (chips, pretzels, soy sauce) … 0 1 2 3
S 8. Has diet of mostly cooked foods ……………….. 0 1 2 3
T 9. Eats margarine regularly …………………………. 0 1 2 3
A 10. Eats white bread, white rice, white sugar ……… 0 1 2 3
R 11. Eats flesh foods daily (meat, fish, foul) ………… 0 1 2 3
T 12. Eats fried or oily foods daily . ……………………. 0 1 2 3
 Rest
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A
C. Rest of Body and Mind – Build up Time
F
0 1 2 3
R 1. Gets no sleep before midnight ……….…………….
2. Goes to bed at different time every night ………... 0 1 2 3
E
S 3. Sleeps in a room with a light or television on …... 0 1 2 3
H 4. Has a pessimistic attitude …………………………... 0 1 2 3
5. Never takes a break at work ………………………… 0 1 2 3
S 6. Always seems to be in a rush ……………………….
T 0 1 2 3
7. Listens to the news at night before bedtime……
A 0 1 2 3
R
T
 Exercise
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A

D. Exercise – Stimulus for Life’s Functions

F
0 1 2 3
R 1. Neglects to get regular exercise ……………………………...
E 0 1 2 3
2. Gets rest or sleep after meals …………………………………
S 0 1 2 3
3. Does hard mental or physical work after eating ……………
H 0 1 2 3
4. Neglects opportunity of breaking a sweat every day………
5. Doesn’t do aerobics to Target Heart Rate every other day.. 0 1 2 3
S
T 6. Doesn’t incorporate strength training into the week………. 0 1 2 3
A 7. Doesn’t do daily stretching or Range of Motion exercises… 0 1 2 3
R
T
 Service
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A

F E. Service – to the Church and God

R
E 1. Neglects to spend time at home with spouse and/or family …….
0 1 2 3
S 2. Never occasionally checks on his/her neighbors ………………… 0 1 2 3
H 0 1 2 3
3. Fails to treat friends as if they are ‘like family’…………………….
0 1 2 3
4. Doesn’t remember new acquaintances ……………………………..
S 0 1 2 3
5. Forgets to offer to volunteer for church jobs ..…………………….
T 0 1 2 3
6. Seldom signs up to do special projects ………………………........
A
0 1 2 3
7. Doesn’t help with the youth ……………………………………………
R
T
 Hydration
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A

F. Hydration: Water – The Best Solvent

F
R
1. Uses unfiltered city water for drinking ………….…………… 0 1 2 3
E
2. Bathes in chlorinated city water ……………………………… 0 1 2 3
S
3. Does not change garments regularly ………………………… 0 1 2 3
H
4. Neglects to take cold showers or steam baths .…………… 0 1 2 3

S 5. Drinks less than 2 quarts (8 cups) of water daily …………. 0 1 2 3

T 6. Fails to study the use of water for simple remedies……….. 0 1 2 3
A 7. Never uses the best water available for use in the kitchen… 0 1 2 3
R
T
 Sunlight
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A

G. Sunlight – Has Healing Power in its Beams

F
R 1. Takes no full body sunbaths …….…………………… 0 1 2 3
E 2. Wears sunglasses in even out of bright sunlight … 0 1 2 3
S 3. Works indoors without light from window.………… 0 1 2 3
H 4. Bedding not exposed to sunlight ....…….................. 0 1 2 3
5. Exposed to sunlight less than one hour daily ......... 0 1 2 3
S
T 6. Doesn’t use ‘sun block’ lotion while out in sun……. 0 1 2 3
A 7. Never wears hat during the hottest part of day…….. 0 1 2 3
R
T
 Temperance
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A
H. Abstemiousness from inhibitors of life’s functions &
Temperance – Moderation in all “good” things
F
R 1. Uses tobacco ………..………………,……………….. 0 1 2 3
E 2. Uses alcohol ………………..…………………………. 0 1 2 3
S 3. Uses coffee / black tea .……………………………..
0 1 2 3
H 4. Eats pork …………..…………………………………..
0 1 2 3
5. Eats cheese…………….………………………………
S 6. Eats chocolate ………….…………………………….
0 1 2 3
T 0 1 2 3
7. Eats spicy foods ……………………………………..
A
R 8. Overeats …………………………………………….... 0 1 2 3
T 9. Overworks ……………………………………………. 0 1 2 3
Continued
Continued

Temperance
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A
H. Abstemiousness – Inhibitors of Life’s Functions &
Temperance – Moderation in All “Good” Things
F
R 9. Overplays ………………………………………………. 0 1 2 3
E 10. Has an idle life …………………………………………
0 1 2 3
S 11. Has sexual problems or excesses ……………….…
12. Uses mustard or vinegar regularly………………… 0 1 2 3
H
13. Sunburns ..……………………………….…………….. 0 1 2 3
S 14. Takes recreational drugs ...…………………………. 0 1 2 3
T 15. Abuses prescribed medications ..………….………
0 1 2 3
A 16. Uses fluoride toothpaste ……………………………..
R 17. Has amalgam fillings in teeth ….……………………. 0 1 2 3
T 18. Uses aluminum cookware …….……………………… 0 1 2 3
 Air
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A

I. Pure Air – Oxygen For Fuel Economy

F
R
1. Spends the week in a polluted city environment …. 0 1 2 3
E
S 2. Uses insecticides or other chemicals in the house .. 0 1 2 3
H 3. Workplace has no open windows ……..................... 0 1 2 3
4. Sleeps in room with window closed …...................... 0 1 2 3
S
5. Home heated with wood heat during winter ....…….. 0 1 2 3
T
A 6. Doesn’t use the stove’s exhaust fan ……..….……… 0 1 2 3
R 7. Decaying matter around the house ……………..…… 0 1 2 3
T
 Trust in Divine Power
0 = Never 1 = Sometimes 2 = Most Times 3 = All Times
A

J. Trust in Divine Power – God Cares

F
R
1. Has unthankful attitude ……………………………… 0 1 2 3
E
S 2. Does not take troubles to God ……………………… 0 1 2 3
H 3. Is chronic worrier ..……………………………………. 0 1 2 3
4. Neglects to read Bible daily ….………………........... 0 1 2 3
S
5. Neglects to witness to others ……………………….. 0 1 2 3
T
A 6. Never sings praises to the Lord……………………… 0 1 2 3
R 7. Forsakes the assembling together with believers… 0 1 2 3
T
 A FRESH START
A parrel -wearing neat and clean, “all natural,” modest clothing.
F ood -eating a good variety of fruits, vegetables, beans, grains, nuts & seeds.
R elationships -dedicated and devoted to “give and take,” to love and to forgive.
E xercise -most days of the week exercise: aerobics, stretching, weight lifting.
S ervice -share well meaning disinterested benevolence.
H ydration -drink at least 6-8 glasses of water, and bath daily.
S unshine -get adequate morning or evening exposure, up to 15-20 minutes.
T emperance -partake in moderation all good things, & avoid toxins & bad drugs.
A ir -perform deep, slow, regular breathing daily.
R est -every night get about 7-8 hours of quality rest & sleep per night.
T rust in God -through prayer, a healthy imagination, & periods of meditation.

Adapted from Dr. Andy Ng’s Mnemonic FRESH START