Name
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First Name
Last Name
What’s the best thing that happened to you since your last check-in due to being on this journey to improved health and wellness? What non scale victories did you notice in the past week?
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Reminder of how to win this journey:
*
Agreed
Disagree
Rate your accuracy in measuring how much you were eating and sticking to the Program the past week *BE HONEST*
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Please Select
Less than 5 (Poor) - did not measure most of my food at all
5-6 (Needs work) - eyeball estimated most of my food
7-8 (Good) - Measured ALMOST every single piece of food I put in my mouth using a scale and wrote it down
9-10 (Excellent) - Measured every single piece of food I put in my mouth using a scale to the last 0.1 gram and wrote it down
Rate for the past week
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Rows
Poor
Needs work
Good
Excellent
1. Preparation
1
2
3
4
2. Single Ingredient Foods
5
6
7
8
3. Hydration
9
10
11
12
4. Exercise Quality
13
14
15
16
5. Going to Bed on Time
17
18
19
20
6. Work Stress
21
22
23
24
7. Home Stress
25
26
27
28
Things I struggled with this past week are....
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Things I did well this past week are...
*
Things I would like to work on improving this upcoming week are...
*
What needs to change this week so you can make progress on the area you'd like to focus on?
*
So your coach can build your exercise schedule, what would you like to do for the upcoming week?
*
Rows
Live workout w/Trainer (via Zoom)
Custom Coach Decide Exercise
Walking / Get in my Steps
Running
Other - something else
No exercise this day
Wednesday
29
30
31
32
33
34
Thursday
35
36
37
38
39
40
Friday
41
42
43
44
45
46
Saturday
47
48
49
50
51
52
Sunday
53
54
55
56
57
58
Monday
59
60
61
62
63
64
Tuesday
65
66
67
68
69
70
On the days you selected "other" what activities would you like put on your calendar?
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Other than your normal fitness & nutrition habits, are there any other habits you'd like to add (or continue) on your calendar for the upcoming week?
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NO OTHER HABITS - I will continue focusing on my main fitness & nutrition habits for now
Drink more Water
Go to Bed on Time
Walk/Get in More Steps
Meal Preparation / Weekly Planning
Other
What time would you like to be in bed by ever night?
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What days / times would you like to meal prep in the week so we can check in on you and hold you accountable to it?
*
Is there anything more I can do to be a better coach for you? What can I do to help you be more successful with your journey? If you were me helping you, what’s one thing you would do differently (if anything)?
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Are you remembering to take ALL your supplements regularly?
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Yes!
Trying to - if I remember
No - but I would like to try some supplements to help me get better results
No - I am not on supplements at this time
Other
Which of the following you have struggled with in the past?
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This matrix type is not available for legacy form layout.
Anything else you'd like your coach to know about this past week? Any other notes, comments, questions or concerns?
Submit
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