Wellness Journal Entry Form
Reflect on your daily wellness, track your habits, and set intentions for your wellbeing.
Date of Entry
*
-
Month
-
Day
Year
Date
How are you feeling today?
*
Very Happy
Happy
Neutral
Sad
Very Sad
Other
How would you rate your energy level today?
*
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
How well did you sleep last night?
*
1
2
3
4
5
Did you do any physical activity today?
*
Yes
No
What physical activities did you do? (If any)
How many glasses of water did you drink today?
*
How would you rate your nutrition today?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How stressed did you feel today?
*
Not Stressed
1
2
3
4
5
6
7
8
9
Extremely Stressed
10
1 is Not Stressed, 10 is Extremely Stressed
List three things you are grateful for today.
*
Personal reflections or notes for today (thoughts, feelings, or anything you'd like to remember)
What is one wellness goal or intention you have for tomorrow?
Submit Journal Entry
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