How energized do you feel on a regular basis? Don’t just think about today, but average out your energy based on the past month, then choose the response that most closely resembles that answer.
Lack of Energy
Abundant Energy
1
I am always tired, even after waking
2
I am tired most of the time
3
I typically get tired later in the day
4
I can make it through half of the day before I get tired
5
I often experience fatigue at least once a day
6
I feel tired at least a few times a week
7
I get fatigued once or twice a week
8
I get tired occasionally after a hard day
9
I am energized most of the time
10
I am always energized
I am always tired, even after waking
Sexual Performance
How is your sexual performance? Take into consideration your level of desire, arousal, performance, and pleasure when determining where your sexual performance falls in the scale below.
Non-Existent Sex Life
Robust Sex Life
1
I have complete erectile failure and dysfunction
2
I am having difficulty maintaining an erection
3
I barely have any desire at all for sex
4
I have very little desire these days
5
Sex – I kind of forgot what that is
6
I try to get in the mood once or twice a month
7
Once a week is enough for me
8
I have sex a few times a week
9
I enjoy sex numerous times a week
10
My sex life is as great as it has always been
I have complete erectile failure and dysfunction
Drive and Productivity
Do you get up each morning ready to take on your piece of the world, or has your drive and motivation seemed to disappear? Choose the response below that best fits how driven, focused, and productive you are.
No Drive, Motivation, and Lack of Productivity
Focused, Driven, Highly Motivated
1
No drive, focus, or desire to do anything
2
Very little drive or desire to get work done
3
Reduced drive and focus, poor performance on the job
4
Barely meets deadlines, not focused on goals or tasks
5
Below average work results, decreased drive
6
Happy to just complete tasks, doesn’t look for extra work
7
Tries to get things done, sometimes misses deadlines
8
Usually well-focused, driven, and meets most deadlines
9
Typically focused, motivated, and gets results
10
Very focused, driven, motivated, over-achiever
No drive, focus, or desire to do anything
Muscle Tone
How does your muscle tone appear now compared to six months or one year ago? You may want to look at photos as a reminder of how your muscles looked in the past.
Total Loss of Muscle Tone and Strength
Well-toned and Chiseled Physique
1
I have lost all muscle tone and strength
2
My muscle tone and strength are seriously failing
3
I have stopped exercising due to decreased strength and endurance
4
I am finding it hard to exercise due to muscle loss and decreased strength
5
I no longer have a toned bodily image
6
My muscle size is shrinking no matter how hard I exercise
7
I am finding it hard to maintain toned muscles with my workouts
8
My muscles are toned, but not where they were in the past
9
My muscles are well-developed with very little body fat
10
My body is firm, chiseled, and well-toned
I have lost all muscle tone and strength
Weight Gain
Have you gained weight for no discernable reason? Where is your weight at today? Choose the number below that corresponds to where you currently are on the scale.
Extreme Weight Gain
Trim and Toned
1
I am more than one hundred pounds overweight
2
I have more than 75 pounds to lose
3
I am more than sixty pounds overweight
4
I have been diagnosed with obesity
5
I need to drop fifty pounds
6
I have thirty to forty pound to lose
7
I am twenty pounds overweight
8
I need to lose ten pounds
9
I could use to lose five pounds
10
I am at my ideal weight
I am more than one hundred pounds overweight
Mental Functions
Are you forgetting why you entered a room or where you placed your keys? Think about your level of concentration, memory, performance of cognitive functions, and then find the response below that best fits that image.
Impaired Cognitive Functions
Sharp Memory and Mental Performance
1
I am extremely forgetful and cannot do simple math calculations in my head anymore
2
I may joke about it, but my lack of memory is scaring me
3
Lack of focus and memory are starting to interfere with my life
4
It is getting harder to focus or recall things that I should know
5
I forget something at least once a day and find it hard to learn new tasks
6
I forget things on a regular basis and lose focus often
7
My memory, focus, and mental skills are not as sharp as in the past
8
I sometimes forget why I entered a room or where I placed something
9
I rarely lose focus or forget anything
10
My mind is as sharp as it ever was
I am extremely forgetful and cannot do simple math calculations in my head anymore
Mood and Depression
Are you still the same happy-go-lucky person you were in years past, or do you find yourself fighting off feelings of depression or mood swings? Pick the response below that best fits the average of how you have felt during the past month.
Severe Depression, Anxiety, Mood Changes
Relaxed, Happy Mood and Demeanor
1
Clinical diagnosis of depression
2
Overall feelings of depression, anxiety, sense of hopelessness
3
Increased mood changes, anxiety, aggression
4
Frequent outbursts, mood swings, increased stress
5
Unhappy with life, concerned about the future, moody
6
Frequent feelings of stress, anxiety, mood changes
7
Mixed feelings for the future, some mood swings
8
Occasional concerns for the future, usually happy
9
Fairly positive outlook, calm, happy mood
10
Positive outlook on life, happy mood, excited
Clinical diagnosis of depression
Sleep
Are you getting enough sleep at night and feeling refreshed and invigorated in the morning? Do not base your answer on only the last few days – average this out over three or four weeks.
I Do Not Sleep Well
I Am Well-Rested and Refreshed
1
I get only a few hours of sleep each night
2
I am always waking up tired from lack of sleep
3
I have a hard time falling asleep and awake frequently during the night
4
I have insomnia that makes it hard to fall asleep most nights
5
I sometimes need a sleeping pill to help me fall asleep
6
I am fine with five hours of sleep each night
7
I average six hours of sleep each night and still awake fairly refreshed
8
I try to get eight hours of sleep each night, but I miss a few nights
9
I typically get eight hours, but not always
10
I wake up refreshed after eight solid hours of sleep each night
I get only a few hours of sleep each night
Hair Loss
Do you still have a thick, full head of hair? Has the color turned gray? Compare the answers in the scale below to find the one that most closely resembles what you are experiencing.
Extreme Loss of Hair from Head and Body
No Hair Loss at All
1
Extreme baldness and hair loss from body
2
Patches of thinning hair very noticeable, increased balding
3
Increased hair thinning on body and head
4
More hair is noticed in brush or comb
5
Thinning hair is starting to cause emotional distress
6
Increased thinning of hair is apparent
7
Reduced growth of hair on body and head
8
Hair on head is losing its shine and thickness
9
Possible hair thinning and a slight increase of hairs in brush or drain
10
Thick, full head of hair
Extreme baldness and hair loss from body
Cholesterol Levels
Have you been diagnosed with high cholesterol? Pick the response closest to what you believe your cholesterol situation to be based on any information received from a doctor or when giving blood.
Extremely High Cholesterol
Normal Cholesterol
1
Extremely high cholesterol that is not responding to medication
2
Extremely high cholesterol that is responding to medication
3
Prescribing of medication to lower cholesterol levels
4
Extremely high cholesterol that is not responding to dietary changes
5
Possible need for medicine for high LDL levels
6
Warning from doctor to change dietary and exercise habits
7
Borderline high LDL levels
8
Slightly elevated LDL levels
9
Barely elevated LDL levels
10
Perfect cholesterol levels
Extremely high cholesterol that is not responding to medication
