Weekly Wellbeing
Name
*
Name
*
First Name
Last Name
Please rate the last week since we spoke (10 = best version):
Sleep Quality
Energy Levels
Digestion
Stress Level (1=low, 10=high)
Mood
Meal Timings
Meal Quality
Workout
Body Confidence
Motivation
Comments about the scale-values for the last week:
Which positive changes did you notice over the course of last week?
What could have been better last week?
How many times per day did you go to the toilet?
How many times per week did you wake up during the night?
How happy are you overall with your progress so far?
1
2
3
4
5
What else do you think you need to achieve your goal?
What questions would you like to get answered in our next meeting?
Submit
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