CM Vitals Assessment | FernCreekChiro

Stress

I frequently feel worried, anxious, or on edge.

I feel overly stressed.

I experience mental fogginess or have trouble concentrating.

I have trouble falling or staying asleep.

In the last six months, I have unintentionally lost or gained 10 or more pounds.

Dietary Health

I typically snack on chips, cookies, crackers or granola bars.

I regularly consume soft drinks or fruit juices.

I have frequent sugar cravings.

I eat within three hours of bedtime.

I regularly eat at restaurants or consume prepared foods from the grocery store.

Environmental Factors

I am sensitive to smells or fragrances.

I regularly have less than one or more than three bowel movements per day.

I take a laxative more than twice a month.

I regularly have headaches or migraines.

I have regular exposure to exhaust fumes, tobacco smoke, pesticides, commercial chemicals, paint, cleaning chemicals, or volatile fumes.

Exercise and Physical Activity

Generally speaking, I enjoy exercising.

I exercise regularly.

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