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Weekly Check-In Form

This form is your space to check in with yourself, your mind, your body, and progress — so I can guide you with the support, strategy, and tweaks you need for the week ahead.

Full Name

Phone Number

Today's Date

Time Zone

How are you feeling this week?

Energy Levels (1-10)

Strength/Endurance Levels (1-10)

Stress Levels (1-10)

Sleep Quality (1-10)

Water Intake (1-10)

Hunger Levels (1-10)

Mind + Body Insights

Are you getting stronger in the gym or noticing performance improvements?

Relationship with food?

(Feeling restricted, balanced, or tempted)

Any big stressors or emotional challenges this week?

Are you currently:

Are you currently:
A
B
C
D
E

Alcohol Check-In

How many days did you consume alcohol last week?

Total number of alcoholic drinks last week (rough estimate):

Reflections + Wins

What's one non-scale victory you're proud of this week?

Your win could be mental, physical, or emotional - anything that made you feel proud, aligned, or accomplished.

Any important dates coming up?

(Weddings, vacations, travel, work trip, etc.)

What can I help you with this week?

(Support, guidance, adjustments, obstacles)