First Name *

Last Name *

Email *

Today's Weight *

How many meals did you eat off-plan (not including your allotted off-plan meals)? *

0

1-2

3-4

5+

No meals, but snacking/grazing

What caused you to go off-plan? (Select all that apply) *

Time constraints

Lack of appetite

Cravings

Social event

Convenience

Stress

How many meals did you substitute? *

0

1-2

3-4

5+

Were those substitutions the same macros as assigned? *

Yes

No

Not sure / N/A

Did you complete all of your assigned training sessions this week? *

Yes

No

If no, how many training sessions did you miss?

0

1

2

3+

What caused you to miss sessions? (Select all that apply) *

Time (time management)

Fatigue

Injury

Travel

Illness

Lack of motivation

Other

If Other:

Did you modify any training sessions? *

Yes

No

If yes, how many sessions did you modify? *

1

2

3+

What did you end up modifying? (Select all that apply)

Replaced exercise

Reduced reps

Reduced sets

Added reps/set

Longer/shorter rest times

Tried to make up for anything missed

Did an at-home workout

Did you complete all of your planned cardio sessions? *

Yes

No

N/A

If no, how many planned cardio sessions did you miss? *

1

2

3+

What caused you to miss cardio? (Select all that apply) *

Time

Fatigue

Injury

Did you modify any cardio sessions? *

Yes

No

N/A

If yes, how many cardio sessions did you modify? *

1

2

3+

How did you modify your cardio?(Select all that apply) *

Reduced duration

Changed type

Lowered intensity

Time (time management)

Fatigue

Injury

Travel

Illness

Lack of motivation

Average hours of sleep per night this week

Under 4

5-6

6-7

8+

Rate your sleep quality (1 = poor, 5 = excellent) *

BadGood

Rate your energy levels (1 = low, 5 = high) *

BadGood

Rate your hunger levels (1 = not hungry, 5 = constantly hungry ) *

BadGood

Rate your digestion (1 = poor (bloated, gassy, backed up, cramps), 5 = excellent &* no issues)) *

BadGood

After what meals or foods? *

Average bowel movements per day *

0

1

2

3

Stress level (1 = low, 5 = high) *

BadGood

Did you take your daily essential supplements consistently? *

Yes

No

If yes, select all that apply: *

Sistem Essentials (Vit D, Probio, multi)

Fish oil

UCII

If no, which did you miss and why? *

Average daily water intake *

0–32 oz

33–64 oz

65–100 oz

100+ oz

Any unusual water retention? *

Yes

No

If yes, where are you noticing it? (e.g. face, ankles, abs) *

Rate your strength this week vs. last *

Stronger

Same

Weaker

How is your post-workout soreness *

None

Slight

Moderate

Very

If sore, which body part(s)? *

Recovery between sessions (1 = poor, 5 = excellent) *

1

2

3

4

5

Any negative self-talk or body image struggles? *

Yes

No

Connection to your goal this week (1 = disconnected, 5 = highly connected) *

1

2

3

4

5

What made you feel most successful this week? What wins can you acknowledge (with your fitness, career, or personal) *

How do you feel about your progress this week? (1 = frustrated, 5 = excellent) *

1

2

3

4

5

Any pain, injury, or discomfort during training? *

Yes

No

If yes, describe the issue and how it impacted training: *

Any upcoming events, travel, or schedule changes next week? *

Would you like to request changes to your plan? *

Yes

No

If yes, describe what you’d like changed: *

Is anything missing from your program?

More support/Accountability

Recipe/meal ideas

Cardio/training variety

Clearer plan

Other

If Oher:

One thing you’re proud of this week: *

Did you face any new challenges that you need help with? If so, please describe. *

Any feedback or concerns about the plan? *

Any questions for the upcoming week or other comments: *

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