Coaching Client Check In

As your health coaches, we look forward to celebrating your success and assisting you with your challenges. Could you please fill out this form. This helps us to track your progress and makes our communication more efficient. This should only take a couple minutes.

Privacy Policy: Any and all information obtained on this form is secure and will never be sold and or shared to anyone outside of this company without your permission.

First Name *

Last Name

Today's date

Email: ( A copy of your results will be sent to you)

How has your program been going? *

Have you noticed any recent changes in your health? Any Non Scale Victories? *

Yes

No

What changes in your health / NSVs are you experiencing?

Are you having any struggles with your program? *

Yes

No

What are your struggles? How can we help?

Please rank the following on a scale of 1-10, where 10 is optimal and 1 is poor

Sleep
Stress
Energy
Physical Activity
Current Motivation

Please provide us with your height and weight so we can track your progress

Height (ft,in)

Starting Weight (lbs)

Current Weight (lbs)

Goal Weight (lbs)

Weight lost (lbs)

0.00

Weight to goal (lbs)

0.00

Percent to goal (%)

0.00

Percent weight loss (%)

0.00

Starting BMI (Body Mass Index)

0.00

Current BMI (Body Mass Index)

0.00

Program systems check: Are you.....? *

Eating within 1 hr of waking up

Eating every 2-3 hrs (6x a day)

Weighing and measuring your portions

Drinking at least 64 oz of water

Reading/working in the book and journal

Participating in the Facebook community

Watching the weekly client support webinar

Is anyone noticing your transformation?

Yes

Not yet

That's awesome! Who is noticing? How did that make you feel?

You are doing great! Would you be interested in exploring what coaching on our team would look like for you?

Yes, let's talk

Possibly, but not yet

No Thank You

Watch this video, and send us a message when you are ready to chat.

Would you like to set up a phone call this week? *

Yes, I would like to talk about my program

No, I will reach out with questions or concerns

Any other questions or needs?

Optional: Progress Photo Upload (confidential and not shared without permission)