An Interactive health goals checklist to help you determine your personal lifestyle goals. For example, if you feel that you need to focus on stress management, check one of the buttons in the high range. If you feel that stress management is not one of your personal health goals, then check one of the buttons in the low range. After you complete the survey, the results will be sent to the Ticket 2 Health program coordinator to help us develop a tool that continues to support your healthy lifestyle goals!

	Low            High
		Feel good about myself
		Grow closer to my family
		Learn to relax
		Stop smoking
		Get more satisfaction from my work
		Stop feeling tired all the time
		Have a more satisfactory sex life
		Learn better management of my time
		Avoid a heart attack
		Get sick less often
		Live longer
		Lose weight
		Lower my blood pressure
		Avoid problems with alcohol
		Handle stress better
		Avoid having cancer
		Sleep soundly
		Get rid of aches and pains
		Get more exercise and physical activity
		Eat a more healthful diet
		Have a better spiritual life
		Reduce my risk of injury

Other health concern(s): (Optional, 100 characters max.)