Personal Wellness Checklist

Print this page to complete your personal wellness checklist.

I know my biggest stress triggers.
Stress triggers: _____________________________________________________________________

I have someone to talk to or a place to write things down, when my stress level is high.
My contact person(s) are: ____________________________________________________________ 

I have a way to relax. 
Relaxing activities: __________________________________________________________________

I eat a variety of foods and get the nutrients I need. I have healthy food on hand.
Healthy foods I like: _________________________________________________________________  

There have been no major changes in my appetite lately.
List any changes or state no change: ___________________________________________________  

I participate in some type of physical activity.
Physical activities and frequency: ______________________________________________________  

I am getting adequate sleep. There have been no major changes in my sleep habits lately.
List amount of sleep/changes: _________________________________________________________  

I am taking my medication as prescribed. I know what to expect from my medication. 
Times I've missed my medication or questions I have: ______________________________________ 

I am involved in social activities.
My social activities include: ___________________________________________________________ 

My friends are aware of my needs, and I am considerate of theirs.  
My needs: ________________________________________________________________________

Needs of my friends: ________________________________________________________________

I have educated my family and loved ones about my illness to the best of my ability.
List of resources or ideas to help further educate: _________________________________________ 

I have a job, hobby or volunteer activity where I feel comfortable. It does not cause too much stress, and I am using and improving my skills.
Job/hobby/activity and skills improved: __________________________________________________