In the past week, please rate how true each of the following statements is to you on a scale of 0 to 4 where:

0 = Not true at all1 = Not very true2 = Somewhat true3 = Very true4 = Extremely true

SleepIt’s easy for me to fall asleep.I stay asleep through the night.I feel like I get enough quality sleep.Even when my sleep is not optimal, I still have plenty of energy to get through the day.When I wake up, I feel rested, alert, and energized.Sleep SubtotalHungerI easily last 5-6 hours without going hungry.I wake up feeling full and comfortably satisfied.My stomach feels comfortable and calm between meals.When I eat, I become full quickly and feel satisfied long after.My hunger is predictable and stable form hour-to-hour and day-to-day.Hunger SubtotalMoodMy mood is stable all day long and remains the same from morning, through afternoon and into the night.I’m laid back and relaxed without worry or anxiety.I return to a happy feeling very quickly after stressful, depressing or hurtful events.From one day to the next, my mood is predictable and essentially the same.My mood remains calm and in control despite what’s going on around me (sights, sounds, temperature, people, etc.)Mood SubtotalEnergyMy energy is stable throughout the day and from one day to the next.If I get exhausted, I rebound quickly and my energy returns to normal fast.I always have the energy I need to do what I want.I enjoy the energy I need without turning to food or caffeinated drinks.I’m easily motivated, stay focused and get things done.Energy Subtotal

CravingsI stop eating once I’m full (or have satisfied a craving) with no problems.I go all day without experiencing cravings.I handle stress without craving certain foods.My thoughts about food come and go and I don’t obsess about anything in particular.I rarely feel the desire for sweets or alcohol after I have already eaten.Cravings Subtotal

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESSGrand Total # Difference to Day 1% Difference to Day 1

In the past week, please rate how true each of the following statements is to you on a scale of 0 to 4 where:

IMPORTANT: Take your first measurements the morning you start, then weekly for the remainder of the program. Do your program finish measurements at the end of week 9.

Beginning Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - - - - - - N/A - - - - - - - N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

IMPORTANT: Take your first measurements the morning you start, then weekly for the remainder of the program. Do your program finish measurements at the end of week 9.

Week 8 Week 9

0 0

0 0

0 0

0 0

0 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - -

#DIV/0! #DIV/0!

IMPORTANT: Take your first measurements the morning you start, then weekly for the remainder of the program. Do your program finish measurements at the end of week 9.

In the past week, please rate each area as follows

0 = Never or almost never have the symptom1 = Occasionally have it, effect is not severe2 = Occasionally have it, effect is severe3 = Frequently have it, effect is not severe4 = Frequently have it, effect is severe IMPORTANT: Take your first measurements the mornig you start, then weekly for the remainder of the program. Do your program finish measurements on the morning of Day 22.

Health Area BeginningBad OdorsUnderarmsBreatheFeetCrotchGas Subtotal 0

Body Heat/SweatingSweaty palms or feetSweat easily/excessive sweatingCold sweats oftenNight sweatsEasily chilledLow tolerance to cold weatherExtremities get cold easily (especially hands and feet)Hot flashes Subtotal 0

FaceLarge pore sizeWrinkles/fine linesPuffinessOilyDryRosacea/flushed

Subtotal 0

SkinDiscolored/purpleAcne/pimples/eczemaItchingScaly/dryness/roughness/ cracking/ psoriasisLooseness/FlappinessBruise easilySkin tags/CystsBrown/sun spotsHives/rashesSoresCellulite/dimples/saggy shadowsStretch marksPoor muscle toneVaricose veinsNumbnessTinglingSearing pain Subtotal 0

MentalDifficulty concentrating or focusingTrouble remembering things/forgetfulnessTend to procrastinateBrain fog/slow thinkingLack of attention to detailTrouble delaying what you want/needs instant gratificationTrouble listeningProblems getting organizedRestless/hyperactiveDifficulty making decisionsStuttering/stammeringSlurred speechConfusion, poor comprehension

Poor physical coordination Subtotal 0

MoodAnger/irritabilityAgitated/restlessAnxiety/stress/worryShort tempered/short fuseSadness/depressionNegative thinkingLow interest in things normally pleasurableMood swings/unstable moodLow self-esteem/lack of confidence/worthlessnessLack of desire to socializeLack of feeling anything/apathy Subtotal 0

EnergyExhausted/fatigued/sluggishApathy/lethargyLack of motivation to exerciseEnergy crashes/drowsy in mid- to late afternoonDrawn to caffeine, sugar/sweets or carbs for energyLow energy or drowsy after meals Subtotal 0

SleepTrouble getting to sleepTrouble staying asleepDon't get enough sleepWake up feeling tiredSleep not restfulExcessive snoring or sleep apneaWake up between 2 a.m. - 4 a.m. for 15 minutes or longer Subtotal 0

Joints and MusclesAches/pains/sorenessStiffnessMobility/flexibilityArthritisLimitation of movementGeneral feeling of weakness/lack of strength Subtotal 0

CravingsSugar/sweetsSimple carbs such as bread, pastaFatty FoodsSalty foodsDairy (milk, ice cream, yogurt, cheese, etc.)AlcoholCoffeeDrugs Subtotal 0

Hunger/AppetiteGet agitated or angry between mealsCan't go more than 3 hours without eatingLightheaded if meals are missedEating relieves fatigueEat to relieve depression or sadnessSkip meals oftenEat late at night or before bedWake up in middle of night hungryFrequently binge eatTrouble stopping eating even when fullNeed to snack oftenCompulsive eating Subtotal 0

Digestion

Passing gasBurpingBloatingStomach/abdominal painAcid refluxHeartburn/GERDCrampingNausea/upset stomachIBS Subtotal 0

HairHair lossDrynessThinning Dandruff/flaky scalpDry scalpItchy scalpRed scalp Subtotal 0

HeadHeadaches/migrainesFaintnessGeneral DizzinessLightheaded, especially when getting upShaky Subtotal 0

NoseTrouble breathingRunny noseStuffy nosePost nasal dripSinus problemsHay fever

Sneezing attacksExcessive mucus formation Subtotal 0

EarsItchy earsEaraches/ear infectionsDrainageTrouble hearingEar pressureRinging/tinnitus Subtotal 0

EyesWatery or itchy eyesSwollen, reddened, or sticky eyelidsBurning sensationMuscle twitching around eyesBags or dark circles under eyesBlurred or tunnel vision (does not include near-or far-sightedness)Sensitive to lightImpaired night vision Subtotal 0

NailsWeakCracked or splitRidged/ripledPuffy nail foldGnawed nailsYellowish/whitish/bluish/pale color Subtotal 0

Mouth/ThroatSorenessItchiness

Chronic coughingDifficulty swallowingGagging reflexFrequent need to clear throatHoarseness, or loss of voiceSwollen or discolored tongue, gum, or lipsCanker soresOverall sense of tasteDry mouthFrequent thirst Subtotal 0

LungsShortness of breathLabored/difficult breathingAsthma/bronchitisSneezing attacksWheezing when breathingCongestion Subtotal 0

HeartIrregular or skipped heartbeatRapid or pounding heartbeatHeart palpitations/racing heartChest painFast pulse rate at restPulse increases after eatingRapid pulse before bed Subtotal 0

EliminationFrequent urinationPain urinatingUrgent urinationWake frequently to urinate

Stool unusual in color, shape or consistencyHard stoolFoul-smelling stoolDiarrheaConstipation Subtotal 0

OtherGenital itching/dischargeTender lymp nodesItchy or stinging anusIrregular periodsBad PMS symptomsRecurring yeast infectionsChronic fungus on nails, skin or athlete's footLack of sex driveFrequently ill or get colds, flu, viruses, etc. Subtotal 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESSGrand Total - # Difference to Day 1 N/A % Difference to Day 1 N/A

IMPORTANT: Take your first measurements the mornig you start, then weekly for the remainder of the program. Do your program finish measurements on the morning of Day 22.

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - - - - - - - - - - - - - - - -

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

IMPORTANT: Take your first measurements the mornig you start, then weekly for the remainder of the program. Do your program finish measurements on the morning of Day 22.

INSTRUCTIONS: Enter your measurement in inches below

Beginning Week 1 Week 2 Week 3 Week 4 Week 5HipsWaistChestBustThighCalveUpper ArmForearmNeck

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS Total - - - - - - # Difference to Day 1 N/A - - - - - % Difference to Day 1 N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!Waist-to-Chest Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!Waist-to-Hip Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Week 6 Week 7 Week 8 Week 9

3

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - - - - - -

#DIV/0! #DIV/0! #DIV/0! #DIV/0!#DIV/0! #DIV/0! #DIV/0! #DIV/0!#DIV/0! #DIV/0! #DIV/0! #DIV/0!

INSTRUCTIONS -- Enter a 1 ONLY if you generally agree with the statement; if not, enter a 0

I am very hungry first thing in the morning.I need coffee/caffeine to get going in the morning.I usually drink more than one cup of coffee or cola a day.I have a difficult time maintaining my ideal weight.I can’t easily go more than 3-4 hours without getting hungry.Eating often relieves my fatigue.I often get moody or irritable before meals.I often feel weak or dizzy if I wait more than 3-4 hours to eat.I often crave sweets and/or caffeine between meals.I often get "shaky" when I’m hungry.I suffer from frequent fatigue or fuzzy thinking that eating relieves.I frequently nibble food between meals because of hunger.I crave candy or coffee/caffeine in afternoonsI’m often tired or drowsy at work.I get anxious and/or depressed when I’m hungry.Once I begin eating sweets, it is very difficult for me to stop.I prefer sweets and starches over all other kinds of food.I can’t fall asleep at night without a snack before bed.I frequently awake in the middle of the night hungry.If I awake at night, I can’t easily go back to sleep without a snack.

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS Total # Difference to Day 1% Difference to Day 1

INSTRUCTIONS -- Enter a 1 ONLY if you generally agree with the statement; if not, enter a 0

Beginning Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - - - - - - N/A - - - - - - - N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Week 8 Week 9

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - -

#DIV/0! #DIV/0!

INSTRUCTIONS: Enter your weight below and your height to the right-- BMI will automatically calculate

Beginning Week 1 Week 2 Week 3 Week 4 Week 5Weight (enter here)BMI (don't enter) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS # Difference to Day 1 N/A - - - - - % Difference to Day 1 N/A #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

INSTRUCTIONS: Enter your weight below and your height to the right-- BMI will automatically calculate

Week 6 Week 7 Week 8 Week 9 Height (in inches) <== Put your height in inches here

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

DO NOT ENTER ANYTHING IN THE FIELDS BELOW -- THESE WILL AUTOMATICALLY CALCULATE TO SHOW YOUR PROGRESS - - - -

#DIV/0! #DIV/0! #DIV/0! #DIV/0!

<== Put your height in inches here