Brain Fitness Form

Brain Fitness Calculator
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Energy level throughout the day
(Low: very tired to High: very energetic)
(Low: totally out of shape to High: in great shape)
Peaceful state of mind
(Low: stressed out and nervous to High: calm and in control)
(Low: chaos at home and work to High: well-organized most of the time)
Positive attitude
(Low: life is tough; everything will fail to high: life is beautiful; everything will work out just fine)
Satisfactory sleep
(Low: trouble falling sleep or up all night to High: sleep well, about 8 hours a night)
Memory for names
(Low: can’t remember anybody’s name to High: remember everybody’s name)
Taking Brain Vitamins
(Low: never or one day a week to High: 5 or more days a week)
Social engagement
(Low: never or one day a week to High: 5 or more days a week)
Sense of curiosity
(Low: not too much into figuring things out to High: love to discover new things and solve puzzles)
Love your daily routine
(Low: dread my day-to-day routine to High: enjoy and love my daily routine)
Heart healthy diet choices
(Low: fast food, donuts, French-fries to High: lots of fruits and vegetables, zero junk food)
Mindful of portion size
(Low: eat large portions and second servings to High: prefer small and reasonable portions)
Extracurricular activities / hobbies
(Low: do not enjoy participating in activities to High: enjoy trying new hobbies, participating in community activities, volunteering, or helping others in my community)
Usual mood
(Low: down and depressed to High: happy and cheerful)