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Email
*
Full Name
*
Step goal/Average Daily Steps
*
How well did you sleep this week?
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How were your stress levels this week?
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Extremely High
High
Normal
Low
Extremely Low
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How were your energy levels this week? (0 being no energy; 10 being off the charts energy)
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0
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4
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10
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How were your hungry levels this week? ( 0 is too full/unable to eat; 10 is starving)
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0
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10
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Average Daily Water Intake in ounces
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Successes you had this week?
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Is there anything you are currently struggling with at the moment?
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Please list any supplements like hormonal and sleep support:
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Anything else you'd like to mention or let your coach know?
*