Name:     Date:     Session #

Tell me one good thing in your life right now:

What positive changes have you noticed since your last appointment?

What are your main concerns at this time?

How has your mood been?     How is your sleep?

Any constipation or diarrhea?     

Any change with weight?

What percent of foods do you cook at home: eat out:

Have you cooked anything new?

What foods do you crave?

What and when are you eating these days? (list some sample meals from your week)

Have you had any meals mindfully? (eating when you are eating, breathing, chewing, tasting your food, and taking your time)

How much water do you drink daily?

What other liquids do you drink?

What vitamins/supplements/herbs are you taking?

How many hours of television do you watch per week?

Have you had any bodywork lately?

What did you do for fun/pleasure since our last visit?

Have you spent time in nature?

What kind of exercises are you doing these days?