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Please fill out this form before our next coaching call. It is a good tool to help you reflect where you are at, what is going well, and anything you may be struggling with. xx

Name*

First Name Last Name

What are your health goals? Be specific. It is good to keep this at the forefront of your mind.

Have you spent the recommended allocated time of 1 hour minimum to read and absorb each module of the programme so far?

YesNo

What recommendations/ actions have you implemented so far during your programme?

Have the above recommendations /actions been easy to implement?

YesNoIn the middle

If no, or in the middle, please explain.

Is there any particular action that you really enjoyed, or felt you have particularly benefited from? Did you notice any positive changes from these actions i.e more energy, less cravings, feeling happier, calmer, more satiated, etc..

Do you feel like you are progressing/improving at a rate you would like?

YesNoIn the middle

If no, or in the middle, please explain.

Are you getting the results you would like?

YesNoin the middle

If no, or in the middle, please explain.

Are there any positive changes in your life as a whole? I.e better relationships, more productive at work? Be sure to celebrate the small positive changes that have occurred.

What challenges have you faced? What did you particularly struggle with? (note any obstacles, practicalities or limiting beliefs that came up for you) It's good to recognise challenges and common themes that keep cropping up)

Is there anything you could do at this point to help you be more successful moving forward ?

What actions do you want to commit to going forward?

What is your immediate short term goal for yourself?

Is there anything regarding the programme and coaching calls that would help you be more successful?

Thank you for taking the time to fill out this form.

I'll look forward to seeing you at our next consultation.

xx