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1 2 3 Diet/nutrition I eat nutritional foods each day. I drink two or less caffeinated drinks a day. I avoid excess salt, fat, and sugar. I drink 8 glasses of water daily 0 1 2 3 Exercise I exercise at least three times each week for at least 30 minutes (total) 0 1 2 3 Expression I express my needs and assert myself 0 1 2 3 Friendships and family I have good social support, friends, and/or family. I can ask for assistance from others 0 1 2 3 Goals I have reasonable and clear goals for myself 0 1 2 3 Humour I can laugh at myself each day 0 1 2 3 Pleasure time I make time for myself each day 0 1 2 3 Reward I pat myself on the back for a job well done or whenever I am pleased with my efforts 0 1 2 3 Self-care I honour myself and tell myself that I am a good and worthy person. I take responsibility for my actions 0 1 2 3 Spirituality I fulfill my spiritual needs through reading, reflection, ceremonies, etc. 0 1 2 3

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