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Please complete and submit this form.
Name
*
First Name
Last Name
WEEKLY REFLECTIONS
How do you feel about your week /what you accomplished since your last check in?
What went well? Share some wins/ things you feel good about!
Why were you successful?
Where did you struggle, and why?
LOOKING AHEAD
What do you need start doing (or keep doing) to be successful next week?
What should you STOP DOING? Is there anything you need to limit, do less of, or eliminate to be successful this next week?
BIOFEEDBACK
CURRENT WEIGHT
*
MENSTRUAL CYCLE
*
List "unknown" if you do not track your cycle or do not have regular periods
MOVEMENT
*
Total steps or daily average since last check in
ADHERENCE
*
Did you execute your plan this week?
YES - NAILED IT!
Kind of - I followed my plan at least 80% of the time
No - I did not have my best week
IF NO,
Please provide details
HUNGER
*
How were your hunger levels
Low - I felt satisfied
Moderate - I noticed my hunger but it was manageable
High - I felt hungry most of the time
DIGESTION
*
How often are you having bowel movements?
Daily
Almost daily/most of the week
Other
IF OTHER,
Please provide details
WATER
*
How much water are you drinking daily
>125 oz
100-125 oz
<100 oz
SLEEP
*
How was your rest and recovery this week?
Good, I got 7+ hours most nights
Poor, I struggled with sleep this week
ENERGY
*
How was your energy overall?
Great!
Normal for me
Poor, I was dragging this week
STRESS
*
How were your stress levels this week?
Low - Life is GOOD!
Mild - Life is happening, but managing well.
Moderate - feeling the pressure, experiencing racing thoughts, feelings of overwhelm, irritable
Severe - Not able to function, basic needs took a backseat.
If applicable,
Elaborate on your biggest stressors
OTHER
Anything else I need to know?
FEEDBACK
*
How would you like your feedback shared with you?
I'd like written feedback only
I'd like voice memos only
No preference
********DON'T FORGET
*
Please verify that you have completed the following things and submitted this check in prior to 12pm PST to receive a response
Movement on calendar marked as complete (comments if not using a Fitbit/ Apple Watch)
Progress photos are uploaded (if applicable)
Stats/measurements are uploaded - left AND right sides (if applicable)
MyFitnessPal is up to date AND synced
I am submitting this before 12p PST
Thank you for submitting your check in! I will respond in the app messenger within 24 hours.
