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Is Your Check In Due? Great! Please complete all the fields below!

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Name

First Name

Last Name

Email Address

Dietary Adherence

How is your diet doing? Were you able to focus on eating out less this past week?

Please provide your protein intake for the week below.

Friday (last week)

Required if you send your check-in on Thursday's

Saturday (last weekend)

Sunday (last weekend)

Monday

Tuesday

Wednesday

Thursday

Friday

Leave blank if you send in check-ins on Thursday's

On average, how many servings of fruit and veggies are you consuming each day?

On average, how much fiber are you consuming each day?

On average, how much liquid (including everything except alcohol) are you consuming each day?

How many times did you eat out last week?

Habits and Goals

What is your long-term identity-based goal?

Comment below if this has changed from last week

What are 2-3 habits you are currently implementing to achieve your identity-based goal?

On a scale of 0-10 (10 being the best) how well did you do with implementing these habits last week?

What's one thing you can do next week to bring this rating closer to 10?

What's something that you did well the past week that you're proud of and can celebrate?

Biofeedback

Where are you at in your menstrual cycle?

How have your bowel movements been?

On a scale of 1 to 10 (1 being poor and 10 being good), how well have you been sleeping?

Why did you give yourself this rating? What's something you can work on to get more sleep?

On average, how many hours of sleep are you getting each night?

On a scale of 1 to 10 (1 being the lowest an 10 being the highest), what would you rate your stress levels at this past couple of weeks?

What's something you can do this week do reduce that rating?

Final Thoughts

What is a positive quote or affirmation that can help shape your week ahead?

Use this quote to set the tone for your new week ahead

Do you have any questions or concerns? Please feel free to provide any general comments not covered thus far. Any positive or negative feedback is always welcome

Optional