Tracking Your Progress
Fill this form out before you start training and please be as detailed as possible.
Client Name:
First Name
Last Name
Date:
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Month
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Day
Year
Date
Email:
example@example.com
Session Number:
Medication I am on (how much, how often):
Please complete:
Rows
Concern:
Pick at least 3 to 5 concerns that you would like to see improvement in. This will help us track progress during training.
Frequency:
How many days out of the week was this experienced? Examples: Every day would be 7 out of 7, "7/7" and half the week, "3/7" or "4/7."
Intensity:
How strong was it on a scale of 1 thru 10, with 1 being not a concern and 10 being extremely concerning.
Duration:
How long did this last? Examples: 15 minutes, 1 hour, 4 hours, 1\2 day, all day. Do not count when you were sleeping
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Submit
Should be Empty: