Name
*
First Name
Last Name
Who is your Coach?
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Coach Jamal
Coach Casey
Coach Rondell
Coach Nikki
Coach Stevanna
Coach Tasha
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:
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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 week
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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
How did this past week go for you? How was this step in the program for you? Did you struggle anywhere? Where did you find you struggled on this step the past week?
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What would you like to focus on improving in the upcoming week?
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What needs to change this week so you can make progress on the area you'd like to focus on? *Please be as SPECIFIC and DETAILED as possible*
*
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 currently taking supplements?
No
Yes
Other
Digestion, bowel movements & overall health in the past week?
*
Please Select
Sick
Normal
Less than Normal (Constipation)
More than Normal (Diarrhea)
You will receive a detailed step by step plan update for the upcoming week(s), but would you ALSO like to request a face-to-face (virtual/in-person) chat with your coach this week?
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No
Yes
For your meeting you've requested this week, would you prefer an in-person or virtual (FaceTime/Zoom) meeting?
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In-person
Virtual
Other
To make the best use of our face-to-face chat time together, answer the following: What topics do you want to cover? and which is the most important of the topics? *Please be as SPECIFIC and DETAILED as possible*
*
For your requested meeting for this upcoming week, what times work best for you in the upcoming week? Please suggest a few time ranges that work well for you.
*
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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