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Weekly Check In Form
Please complete this form answering as honestly and accurately as possible (should take approx. 6-8 mins)
21
Questions
START
1
1) What is your
FULL NAME
?
*
This field is required.
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2
2) How would you
RATE YOUR MOST RECENT WEEK
?
*
This field is required.
GREEN (EXCELLENT) - I’m happy with the way things are going/NO ACTION NEEDED
AMBER (OK) - But I know that I need to improve on a few things/feedback via WHATSAPP VOICE NOTE
RED (I NEED HELP!) - I would like to book a CALL to get back on track
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3
3) List 3 or more things that have gone well this week? What
WINS
would you like to share?
*
This field is required.
This can be anything such as training, steps, nutrition, sleep etc.
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4
4) What things do you need to
IMPROVE ON
?
*
This field is required.
List as many things as you feel appropriate.
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5
5) How would you rate your adherence/performance with
TRAINING
?
*
This field is required.
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8
9
10
POOR
EXCELLENT
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6
6) How would you rate adherence to
NUTRITION
?
*
This field is required.
1
2
3
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9
10
POOR
EXCELLENT
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7
7) How would you rate your
SLEEP AND RECOVERY
?
*
This field is required.
1
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3
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9
10
Poor
Excellent
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8
8) How would you rate your current
ENERGY LEVELS
?
*
This field is required.
1
2
3
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10
Poor
Excellent
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9
9) What is your latest scale
WEIGHT
reading in
KG
?
*
This field is required.
Must be done on an empty stomach first thing in the morning
KG
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10
10) Has this gone
UP
or
DOWN
? If so by
HOW MUCH
in kg?
*
This field is required.
KG
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11
11) Please upload a print screen of your
WEEK VIEW CALORIES
from MyFitnessPal.
*
This field is required.
This can be changed from day view by clicking the arrow at the top of the screen.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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12
12) Please upload a print screen of your
WEEK VIEW NUTRIENTS
from MyFitnessPal.
*
This field is required.
This can be changed from day view by clicking the arrow at the top of the screen.
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Max. file size
: 10.6MB
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13
13) Have you stuck to your
CALORIE GOAL
in the last week? (Please explain and give a bit of detail).
*
This field is required.
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14
14) On average how many litres of
WATER
per day have you been drinking?
*
This field is required.
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15
15) Please upload a print screen of your
WEEKLY STEPS
from your phone.
*
This field is required.
Use whatever app or platform you use to track steps.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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16
16) How is
WORK, FAMILY, SOCIAL LIFE
etc? Is there anything that is negatively affecting your progress?
*
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17
17) Are there any exercises that you're currently struggling with?
Leave blank if no
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18
18) Are there any exercises that you're enjoying or progressing well with?
*
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19
19) Are you happy with the level of support you're receiving from me right now?
*
This field is required.
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20
20) Can you attend this weeks Zoom Open Office?
*
This field is required.
(Every Tuesday at 7.00pm-7.30pm)
YES
NO
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21
21) Is there anything specific you would like me to help you with/send
FEEDBACK
on?
*
This field is required.
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