My Sharper Brain
Complete this scaled 1–10 check-in to help us understand your daily experience and support your care plan.
Full Name
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First Name
Last Name
Phone
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Format: (000) 000-0000.
Email
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Self-Perception
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1 – I rarely feel confident or positive about myself.
3 – I sometimes feel good about myself but often struggle with self-worth.
5 – I have an average sense of self-worth and confidence.
8 – I usually feel confident and have a positive self-image.
10 – I consistently feel strong, confident, and secure in who I am.
Focus & Mental Clarity
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1 – My thoughts are often scattered and I struggle to focus.
3 – I have trouble concentrating and get easily distracted.
5 – I can focus when needed but sometimes experience mental fog.
8 – I usually think clearly and stay focused on tasks.
10 – My mind is consistently sharp, clear, and attentive.
Anxiety & Nervous System State
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1 – I feel anxious or on edge most of the time.
3 – I experience frequent anxiety and find it hard to relax.
5 – I have some anxiety but can manage it most days.
8 – I feel calm and relaxed most of the time.
10 – I am consistently calm, centered, and free from anxiety.
Sleep Quality
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1 – I rarely sleep well and often feel tired during the day.
3 – My sleep is inconsistent and I often wake up unrefreshed.
5 – I get enough sleep but sometimes have trouble staying asleep.
8 – I usually sleep well and wake up feeling rested.
10 – I consistently sleep deeply and wake up energized.
Motivation & Drive
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1 – I rarely feel motivated or enthusiastic about daily activities.
3 – I struggle to find motivation and often feel apathetic.
5 – I have average motivation and can get things done when needed.
8 – I am usually motivated and approach tasks with energy.
10 – I am consistently driven and enthusiastic about my goals.
As an ongoing weekly assessment, we average responses to all five questions—with higher scores indicating better outcomes—and aim for minimum of 50% improvement by the end of 5 months of training.
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