Diet Setback Recovery Form
Reflect on your recent diet setback and create a practical plan for moving forward.
What happened during your recent diet setback?
*
When did the setback occur?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you describe your current eating patterns?
*
What do you think triggered this setback?
Stress
Social situations
Lack of planning
Emotional eating
Travel or schedule changes
Other
How did you feel during and after the setback?
What support or resources would help you recover?
Accountability partner
Meal planning tools
Motivational content
Professional guidance
Peer support group
Other
What are your top three priorities for getting back on track?
What specific action steps will you take to recover from this setback?
*
How confident do you feel about your recovery plan?
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Is there anything else you'd like to share about your experience or needs?
Submit
Should be Empty: