How’s My Health?

How’s My Health?

Take a look at your current health and set goals to get on track to a healthier lifestyle.

Personal Wellness Plan
People who are successful at making lifestyle changes take time to write out a specific goals and a plan of action. Use this work sheet to write out your goals and action plans. Review the various area of your health. Decide in which areas you would like to make improvement. List your present situation and specify your goals (what you want to accomplish) in measurable terms.
Keep track of your progress. Review your goals regularly. Get help from others as needed.

Personal wellness plan for: ___________________________ Start date: _____________

Weight Goal: Present weight________ Weight goal in 6 months: ________

Action plans:

 

 

Blood Pressure (BP): Present BP ______________ BP goal in 6 months: ________________

Action plans:

 

 

Blood Cholesterol: Present Total cholesterol level ________ HDL cholesterol level _________

Present Total cholesterol level ________ HDL cholesterol level _________

Action plans:

 

 

Healthy Eating: Specific things I want to do to improve my eating habits.

Action plans:

 

 

Physical activity: Number of days/week I currently get 30+ min of physical activity ________

Goals: Active days/week ________ Kinds of activities: ________________________________

Action plans:

 

 

Stress and Coping: Ways I can improve mental/emotional health and coping skills:
Action plans:

 

 

Preventive Exams: Health tests and exams I want to do to keep current in my preventive exams:
Action plans:

 

 

Addictive Behaviors: Habits I would like to change that seem to control me such as smoking, alcohol, drugs, gambling, binge eating, excessive work that damages my health and family life, or excessive TV viewing.
Action plans:

 

 

Spiritual Health: Values, virtues, or service to others I would like to incorporate into my life that would provide meaning, purpose, peace, and enrichment to my life and to others.
Action plans:

 

 

Other changes: