• The Vitality Score

    Rate each item based on how much it’s affected your life over the past 2 weeks, from 0 (not a problem) to 4 (it dominates your day).

  • Respondent Information

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Energy & Stamina

  • Running low on energy before the day is done*
  • Pushing through constant tiredness*
  • A slump or crash in the afternoon*
  • Worn out by tasks that used to feel easy*
  • Little motivation to start or finish things*

  • Sleep & Recovery

  • Trouble falling asleep*
  • Waking in the night and struggling to settle again*
  • Waking too early and not getting back to sleep*
  • Waking up unrefreshed, as if you barely slept*
  • Restless, light, or poor-quality sleep*

  • Mind & Focus

  • Mental fog or cloudy thinking*
  • Losing your train of thought or the word you want*
  • Forgetting names, plans, or why you entered a room*
  • Trouble concentrating or staying on task*
  • Feeling slow or stuck on everyday decisions*

  • Mood & Emotional Balance

  • Moods shifting quickly for little reason*
  • Feeling irritable or short-tempered*
  • Worry, nervousness, or a racing mind*
  • Feeling flat, low, or tearful*
  • Feeling easily overwhelmed by normal demands*

  • Hormonal & Temperature

  • Hot flashes or sudden waves of heat*
  • Night sweats that disrupt your sleep*
  • A racing, pounding, or skipping heartbeat*
  • Less interest in sex than you would like*
  • Vaginal dryness or discomfort*

  • Weight & Metabolism

  • Gaining weight, especially around the middle*
  • Strong cravings for sugar or carbs*
  • Feeling shaky, irritable, or hangry between meals*
  • Puffiness or bloating from holding water*
  • A metabolism that feels stuck or slow*

  • Digestion & Gut

  • Bloating or a distended belly*
  • Excess gas or frequent belching*
  • Constipation or difficulty going*
  • Loose, urgent, or unpredictable stools*
  • Heartburn, reflux, or stomach discomfort*

  • Joints, Muscles & Pain

  • Aching or tender joints*
  • Stiffness or reduced range of motion*
  • Muscle aches or soreness*
  • Muscle weakness or heaviness*
  • Headaches*

  • Skin, Hair & Appearance

  • Thinning hair or more shedding than usual*
  • Dry, itchy, or rough skin*
  • Breakouts or adult acne*
  • Brittle or splitting nails*
  • Puffiness or dark circles under the eyes*

  • Whole-Body & Immune

  • Catching illnesses more often or recovering slowly*
  • Nasal congestion, sinus issues, or allergy flares*
  • Needing to urinate more often or urgently*
  • Dizziness or lightheadedness*
  • Tingling or numbness in the hands or feet*
  • Should be Empty: